Provider First Line Business Practice Location Address:
924 FULTON AVE SW
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:
35211-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-786-0315
Provider Business Practice Location Address Fax Number:
205-788-2663
Provider Enumeration Date:
06/15/2006