Provider First Line Business Practice Location Address:
52 WATER WORKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DADEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36853-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-825-2740
Provider Business Practice Location Address Fax Number:
256-825-2743
Provider Enumeration Date:
08/31/2006