Provider First Line Business Practice Location Address:
2018 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
PROFESSIONAL OFFICE BLDG SUITE 115
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-802-1430
Provider Business Practice Location Address Fax Number:
205-802-1343
Provider Enumeration Date:
12/22/2006