Provider First Line Business Practice Location Address:
1655 COUNTY ROAD 79
Provider Second Line Business Practice Location Address:
ATTN: DR. ADIEL BREWSTER-GREENSTEIN
Provider Business Practice Location Address City Name:
FORT PAYNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35967-5835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-701-0699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2008