Provider First Line Business Practice Location Address:
1200 17TH ST SO
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-212-6713
Provider Business Practice Location Address Fax Number:
205-212-6688
Provider Enumeration Date:
09/07/2006