Provider First Line Business Practice Location Address:
12701 PADGETT SWITCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36544-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-824-2174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2010