Provider First Line Business Practice Location Address:
204 PRAIRIE ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION SPRINGS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36089-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-738-2320
Provider Business Practice Location Address Fax Number:
334-738-2376
Provider Enumeration Date:
06/29/2006