Provider First Line Business Practice Location Address:
52 MEDICAL PARK EAST DRIVE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-838-3025
Provider Business Practice Location Address Fax Number:
205-838-3897
Provider Enumeration Date:
01/04/2007