Provider First Line Business Practice Location Address:
401 TUSCALOOSA AVE SW
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35211-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-785-7901
Provider Business Practice Location Address Fax Number:
205-785-7904
Provider Enumeration Date:
10/16/2006