Provider First Line Business Practice Location Address:
1215 7TH ST SE
Provider Second Line Business Practice Location Address:
SUITE 140/120
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-341-0152
Provider Business Practice Location Address Fax Number:
256-341-0587
Provider Enumeration Date:
02/28/2007