Provider First Line Business Practice Location Address:
619 SOUTH 19TH STREET
Provider Second Line Business Practice Location Address:
NHB 525
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-4680
Provider Business Practice Location Address Fax Number:
205-934-3100
Provider Enumeration Date:
01/04/2007