Provider First Line Business Practice Location Address:
1712 5TH AVE 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:
35203-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-323-4608
Provider Business Practice Location Address Fax Number:
205-252-0203
Provider Enumeration Date:
11/08/2005