Provider First Line Business Practice Location Address:
LHRB 112
Provider Second Line Business Practice Location Address:
1530 3RD AVENUE S
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-996-4028
Provider Business Practice Location Address Fax Number:
205-975-7294
Provider Enumeration Date:
04/15/2008