Provider First Line Business Practice Location Address:
817 PRINCETON AVENUE S.W.
Provider Second Line Business Practice Location Address:
POB II; SUITE 302
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-781-6995
Provider Business Practice Location Address Fax Number:
205-781-8783
Provider Enumeration Date:
10/03/2006