Provider First Line Business Practice Location Address:
6 61ST ST N
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:
35212-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-595-5361
Provider Business Practice Location Address Fax Number:
205-591-1390
Provider Enumeration Date:
03/27/2007