Provider First Line Business Practice Location Address:
474 HIGHWAY 67 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35603-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-353-0100
Provider Business Practice Location Address Fax Number:
256-353-0299
Provider Enumeration Date:
03/19/2008