Provider First Line Business Practice Location Address:
1530 3RD AVE S
Provider Second Line Business Practice Location Address:
KAUL 202C
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-9500
Provider Business Practice Location Address Fax Number:
205-975-6389
Provider Enumeration Date:
10/13/2005