Provider First Line Business Practice Location Address:
3240 EDWARDS LAKE PKWY STE 200
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:
35235-3128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-661-1234
Provider Business Practice Location Address Fax Number:
205-661-0579
Provider Enumeration Date:
12/13/2006