Provider First Line Business Practice Location Address:
1808 7TH AVENUE SOUTH BOSHELL DIABETES BUILDING RM 396
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:
35294-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-996-9752
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2022