Provider First Line Business Practice Location Address:
4616 HIGHWAY 280 S
Provider Second Line Business Practice Location Address:
T1772
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-991-6248
Provider Business Practice Location Address Fax Number:
205-991-6248
Provider Enumeration Date:
06/21/2011