Provider First Line Business Practice Location Address:
240 JOHNSTON ST SE
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:
35601-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-350-5585
Provider Business Practice Location Address Fax Number:
256-350-3769
Provider Enumeration Date:
11/08/2005