Provider First Line Business Practice Location Address:
101 BAKER AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLANTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-755-1231
Provider Business Practice Location Address Fax Number:
205-755-2300
Provider Enumeration Date:
11/14/2006