Provider First Line Business Practice Location Address:
1540 E SOUTH ST
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:
36853-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-825-8501
Provider Business Practice Location Address Fax Number:
256-825-0369
Provider Enumeration Date:
08/31/2006