Provider First Line Business Practice Location Address:
48 MEDICAL PARK DR E STE 154
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:
35235-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-838-3356
Provider Business Practice Location Address Fax Number:
205-838-3357
Provider Enumeration Date:
07/31/2006