Provider First Line Business Practice Location Address:
1216 25TH ST N
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:
35234-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-252-2994
Provider Business Practice Location Address Fax Number:
205-254-6076
Provider Enumeration Date:
09/30/2020