Provider First Line Business Practice Location Address: 
3504 OLD LEEDS TER
    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: 
35213-3218
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-870-1870
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/19/2006