Provider First Line Business Practice Location Address:
924 19TH ST S
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:
35205-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-604-6212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2026