Provider First Line Business Practice Location Address:
1413 W QUITMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IUKA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38852-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-424-9550
Provider Business Practice Location Address Fax Number:
662-424-9558
Provider Enumeration Date:
02/07/2006