Provider First Line Business Practice Location Address:
21549 AL HIGHWAY 79
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35768-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-587-3332
Provider Business Practice Location Address Fax Number:
256-587-3352
Provider Enumeration Date:
07/21/2006