Provider First Line Business Practice Location Address:
42030 HIGHWAY 195
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HALEYVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-485-7337
Provider Business Practice Location Address Fax Number:
205-485-7393
Provider Enumeration Date:
08/24/2006