Provider First Line Business Practice Location Address:
1517 19TH STREET ENSLEY
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:
35218-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-785-0055
Provider Business Practice Location Address Fax Number:
205-780-5223
Provider Enumeration Date:
08/04/2006