Provider First Line Business Practice Location Address:
817 PRINCETON AVE SW
Provider Second Line Business Practice Location Address:
PROFESSIONAL BLDG 2 SUITE 202
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35211-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-786-8815
Provider Business Practice Location Address Fax Number:
205-786-8835
Provider Enumeration Date:
04/18/2006