Provider First Line Business Practice Location Address:
1504 SPRINGHILL AVE, UNIVERSITY OF SOUTH ALABAMA
Provider Second Line Business Practice Location Address:
DEPARTMENT OF FAMILY MEDICINE, RM 3414
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-3273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-434-3480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2011