Provider First Line Business Practice Location Address:
221 E SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DADEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-825-0063
Provider Business Practice Location Address Fax Number:
256-825-5584
Provider Enumeration Date:
02/09/2007