Provider First Line Business Practice Location Address:
1416 MOULTON ST E
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:
35601-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-560-0180
Provider Business Practice Location Address Fax Number:
256-560-0190
Provider Enumeration Date:
12/26/2012