Provider First Line Business Practice Location Address:
5021 US HWY 280
Provider Second Line Business Practice Location Address:
INVERNESS HEIGHTS S/C STE #101
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-995-6065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007