Provider First Line Business Practice Location Address:
1301 HOUSE OF PRAYER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSKEGEE INSTITUTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36088-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-332-0504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2024