Provider First Line Business Practice Location Address:
1617 11TH 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:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-4885
Provider Business Practice Location Address Fax Number:
205-417-2817
Provider Enumeration Date:
02/08/2006