Provider First Line Business Practice Location Address:
WIREGRASS CLINIC LLC
Provider Second Line Business Practice Location Address:
4300 WMAIN ST, STE 21
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-1534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006