Provider First Line Business Practice Location Address:
7402 HIGHWAY 69 S
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-752-0320
Provider Business Practice Location Address Fax Number:
205-752-0993
Provider Enumeration Date:
09/13/2006