Provider First Line Business Practice Location Address:
1930 EDWARDS LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 136
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-655-7231
Provider Business Practice Location Address Fax Number:
205-655-7232
Provider Enumeration Date:
03/14/2011