Provider First Line Business Practice Location Address:
1425 21ST ST S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-3898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-9582
Provider Business Practice Location Address Fax Number:
205-933-6617
Provider Enumeration Date:
09/13/2005