Provider First Line Business Practice Location Address:
124A SOUTH UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-343-5004
Provider Business Practice Location Address Fax Number:
251-343-5136
Provider Enumeration Date:
12/15/2005