Provider First Line Business Practice Location Address:
2151 HIGHLAND AVE SOUTH
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-5744
Provider Business Practice Location Address Fax Number:
205-933-6666
Provider Enumeration Date:
10/13/2010