Provider First Line Business Practice Location Address:
15622 S. US HWY 231
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36350-0695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-983-3558
Provider Business Practice Location Address Fax Number:
334-983-3255
Provider Enumeration Date:
07/13/2007