Provider First Line Business Practice Location Address:
105 HIGHWAY 80 EAST
Provider Second Line Business Practice Location Address:
SUITE DME 1
Provider Business Practice Location Address City Name:
DEMOPOLIS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-289-0565
Provider Business Practice Location Address Fax Number:
334-289-0567
Provider Enumeration Date:
05/23/2006