Provider First Line Business Practice Location Address:
221 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:
36853-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-825-0063
Provider Business Practice Location Address Fax Number:
256-825-5584
Provider Enumeration Date:
07/25/2008