Provider First Line Business Practice Location Address:
1013 MEDICAL CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-0522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-874-7670
Provider Business Practice Location Address Fax Number:
334-875-7942
Provider Enumeration Date:
08/22/2006