Provider First Line Business Practice Location Address:
1600 20TH STREET SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-212-5621
Provider Business Practice Location Address Fax Number:
205-212-5660
Provider Enumeration Date:
11/16/2006