Provider First Line Business Practice Location Address:
1608 LANGSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBON HILL
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35549-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-471-5388
Provider Business Practice Location Address Fax Number:
205-924-8600
Provider Enumeration Date:
02/01/2011