Provider First Line Business Practice Location Address:
600 UNIVERSITY BLVD E
Provider Second Line Business Practice Location Address:
SUITE B-3
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-2067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-750-8008
Provider Business Practice Location Address Fax Number:
205-750-8152
Provider Enumeration Date:
04/03/2008