Provider First Line Business Practice Location Address:
944 18TH ST S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-870-4343
Provider Business Practice Location Address Fax Number:
205-870-0299
Provider Enumeration Date:
07/20/2006