Provider First Line Business Practice Location Address:
221 20TH STREET NORTH
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:
35203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-320-3296
Provider Business Practice Location Address Fax Number:
205-320-3299
Provider Enumeration Date:
07/07/2006