Provider First Line Business Practice Location Address:
13521 OLD HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-408-4484
Provider Business Practice Location Address Fax Number:
205-408-4454
Provider Enumeration Date:
02/25/2010