Provider First Line Business Practice Location Address:
1005 CITY AVE N
Provider Second Line Business Practice Location Address:
1005 CITY AVENUE NORTH
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38663-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-837-9221
Provider Business Practice Location Address Fax Number:
662-837-2110
Provider Enumeration Date:
06/21/2006