Provider First Line Business Practice Location Address:
545 JUDGE LOGUE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36352-8607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-692-5553
Provider Business Practice Location Address Fax Number:
334-692-5554
Provider Enumeration Date:
08/15/2006