Provider First Line Business Practice Location Address:
933 S 19TH ST
Provider Second Line Business Practice Location Address:
CH19 ROOM 115
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-9281
Provider Business Practice Location Address Fax Number:
205-934-1302
Provider Enumeration Date:
10/03/2006