Provider First Line Business Practice Location Address:
1417 14TH STREET SOUTH
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-541-9867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2010