Provider First Line Business Practice Location Address:
200 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35402-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-759-0904
Provider Business Practice Location Address Fax Number:
205-759-0931
Provider Enumeration Date:
09/12/2006