Provider First Line Business Practice Location Address:
832 PRINCETON AVENUE, S.W.
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:
35211-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-206-8461
Provider Business Practice Location Address Fax Number:
205-397-0586
Provider Enumeration Date:
07/22/2005