Provider First Line Business Practice Location Address:
202 HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOULTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35650-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-974-2206
Provider Business Practice Location Address Fax Number:
256-974-2205
Provider Enumeration Date:
05/15/2014