Provider First Line Business Practice Location Address:
1400 NARROW LN P
Provider Second Line Business Practice Location Address:
BMA OF MONTGOMERY BAPTIST CKD SERVICES
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-286-4011
Provider Business Practice Location Address Fax Number:
334-286-4108
Provider Enumeration Date:
05/23/2006