Provider First Line Business Practice Location Address: 
28190 NORTH MAIN STREET
    Provider Second Line Business Practice Location Address: 
FAMILY CHIROPRACTIC AND HEALTH CENTER PC SUITE A
    Provider Business Practice Location Address City Name: 
DAPHNE
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
36526
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
251-621-0700
    Provider Business Practice Location Address Fax Number: 
251-621-8187
    Provider Enumeration Date: 
09/26/2006