Provider First Line Business Practice Location Address:
1104 US HIGHWAY 280 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-664-2241
Provider Business Practice Location Address Fax Number:
334-664-2242
Provider Enumeration Date:
08/16/2007