Provider First Line Business Practice Location Address:
211 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BAY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35582-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-386-4005
Provider Business Practice Location Address Fax Number:
256-386-4685
Provider Enumeration Date:
09/28/2006