Provider First Line Business Practice Location Address:
1020 26TH STREET SOUTH
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:
35209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-397-1275
Provider Business Practice Location Address Fax Number:
205-397-1279
Provider Enumeration Date:
07/24/2006