Provider First Line Business Practice Location Address: 
1774 MCFARLAND BLVD N
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TUSCALOOSA
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
35406-2136
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-759-2920
    Provider Business Practice Location Address Fax Number: 
205-759-1344
    Provider Enumeration Date: 
06/09/2006