Provider First Line Business Practice Location Address:
712 29TH ST S
Provider Second Line Business Practice Location Address:
SUITE B-2
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-908-2456
Provider Business Practice Location Address Fax Number:
866-469-3880
Provider Enumeration Date:
11/15/2007