Provider First Line Business Practice Location Address:
1517 4TH AVE SOUTH
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:
35233-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-322-5498
Provider Business Practice Location Address Fax Number:
205-322-5523
Provider Enumeration Date:
04/18/2006