Provider First Line Business Practice Location Address:
1211 28TH ST S
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-879-1671
Provider Business Practice Location Address Fax Number:
205-879-1671
Provider Enumeration Date:
03/27/2012