Provider First Line Business Practice Location Address:
1951 MAIN STR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36048-0125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-266-5210
Provider Business Practice Location Address Fax Number:
334-266-5630
Provider Enumeration Date:
10/31/2006