Provider First Line Business Practice Location Address:
2700 HIGHWAY 280 EAST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-879-2221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005