Provider First Line Business Practice Location Address:
LIFE SKILLS CLINIC
Provider Second Line Business Practice Location Address:
42D ABW MEDICAL GROUP
Provider Business Practice Location Address City Name:
MAXWELL AFB
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-953-5055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006