Provider First Line Business Practice Location Address:
628 GADSDEN HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-836-6050
Provider Business Practice Location Address Fax Number:
205-836-5275
Provider Enumeration Date:
12/19/2006