Provider First Line Business Practice Location Address:
HIGHWAY 8 EAST
Provider Second Line Business Practice Location Address:
C/O BOLIVAR MEDICAL CENTER
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-846-2470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006