Provider First Line Business Practice Location Address:
924 FULTON AVENUE
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:
35211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-780-6333
Provider Business Practice Location Address Fax Number:
205-780-6008
Provider Enumeration Date:
06/26/2006