Provider First Line Business Practice Location Address:
4606 HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-437-1280
Provider Business Practice Location Address Fax Number:
205-437-8105
Provider Enumeration Date:
10/25/2006