Provider First Line Business Practice Location Address:
52 MEDICAL PARK DRIVE EAST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-838-3888
Provider Business Practice Location Address Fax Number:
205-838-3875
Provider Enumeration Date:
10/12/2006