Provider First Line Business Practice Location Address:
703 19TH ST S
Provider Second Line Business Practice Location Address:
THE UNIVERSITY OF ALABAMA AT BIRMINGHAM, ZRB 522
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-975-3304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2007