Provider First Line Business Practice Location Address:
2131 MAGNOLIA AVE S STE 100
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:
35205-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-322-4382
Provider Business Practice Location Address Fax Number:
205-322-5175
Provider Enumeration Date:
08/31/2006