Provider First Line Business Practice Location Address:
2117 DECATUR HIGHWAY, SUITE 131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDENDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-418-1270
Provider Business Practice Location Address Fax Number:
205-418-1271
Provider Enumeration Date:
01/22/2007