Provider First Line Business Practice Location Address:
1211 27TH PL S
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:
35205-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-322-2121
Provider Business Practice Location Address Fax Number:
205-322-2162
Provider Enumeration Date:
02/17/2009