Provider First Line Business Practice Location Address:
3425 COLONNADE PKWY STE B
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:
35243-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-203-4501
Provider Business Practice Location Address Fax Number:
205-677-0840
Provider Enumeration Date:
10/21/2005