Provider First Line Business Practice Location Address:
901 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:
36701-6746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-2640
Provider Business Practice Location Address Fax Number:
334-875-2645
Provider Enumeration Date:
06/30/2005