Provider First Line Business Practice Location Address:
1222 14TH AVE S
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:
35205-5336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-558-3244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2008