Provider First Line Business Practice Location Address:
321 19TH STREET ENSLEY
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:
35218-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-788-2200
Provider Business Practice Location Address Fax Number:
205-788-2201
Provider Enumeration Date:
06/16/2006