Provider First Line Business Practice Location Address:
8476 U S HWY 231 ADMH DIVISION OF INTELLECTUAL DISABILI
Provider Second Line Business Practice Location Address:
COMPREHENSIVE SUPPORT SVCS RIV & V
Provider Business Practice Location Address City Name:
WETUMPKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-514-4268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2007