Provider First Line Business Practice Location Address:
15079 S US HIGHWAY 231
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36350-6305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-983-5994
Provider Business Practice Location Address Fax Number:
334-983-4954
Provider Enumeration Date:
09/22/2006