Provider First Line Business Practice Location Address:
2313 6TH ST
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:
35401-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-758-3611
Provider Business Practice Location Address Fax Number:
205-758-9441
Provider Enumeration Date:
09/16/2006