Provider First Line Business Practice Location Address:
1310 ALFORD AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35226-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-979-6822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006