Provider First Line Business Practice Location Address:
6525 OLD GREENSBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-5993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-248-6242
Provider Business Practice Location Address Fax Number:
205-752-1929
Provider Enumeration Date:
11/20/2006