Provider First Line Business Practice Location Address:
1430 GADSDEN HWY
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-661-0003
Provider Business Practice Location Address Fax Number:
205-661-3017
Provider Enumeration Date:
11/07/2005