Provider First Line Business Practice Location Address:
5381 1ST AVENUE, 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:
35212-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-592-2561
Provider Business Practice Location Address Fax Number:
205-595-7641
Provider Enumeration Date:
09/22/2006