Provider First Line Business Practice Location Address:
16003 AL HIGHWAY 35 RM 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35768-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-519-1139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2025