Provider First Line Business Practice Location Address:
48 MEDICAL PARK DR E STE 153
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:
35235-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-402-8133
Provider Business Practice Location Address Fax Number:
205-402-8138
Provider Enumeration Date:
04/23/2013