Provider First Line Business Practice Location Address:
1164 1ST ST N
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:
35549-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-387-4646
Provider Business Practice Location Address Fax Number:
205-387-4656
Provider Enumeration Date:
01/17/2008