Provider First Line Business Practice Location Address:
801 PRINCETON AVE SW
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:
35211-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-780-7712
Provider Business Practice Location Address Fax Number:
205-744-2334
Provider Enumeration Date:
10/10/2005