Provider First Line Business Practice Location Address:
210 HWY 59 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URIAH
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-862-2431
Provider Business Practice Location Address Fax Number:
251-862-2096
Provider Enumeration Date:
03/06/2007