Provider First Line Business Practice Location Address:
1830 14TH AVE 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:
35205-4969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-5511
Provider Business Practice Location Address Fax Number:
205-939-0150
Provider Enumeration Date:
10/16/2006