Provider First Line Business Practice Location Address:
1813 6TH AVE SOUTH
Provider Second Line Business Practice Location Address:
M152
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-975-2477
Provider Business Practice Location Address Fax Number:
205-975-6963
Provider Enumeration Date:
07/20/2005