Provider First Line Business Practice Location Address:
1300 27TH PL S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-939-3602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2008