Provider First Line Business Practice Location Address: 
1600 7TH AVE S
    Provider Second Line Business Practice Location Address: 
SUITE 420 ACC
    Provider Business Practice Location Address City Name: 
BIRMINGHAM
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
35233-1711
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-939-9235
    Provider Business Practice Location Address Fax Number: 
205-939-9936
    Provider Enumeration Date: 
12/07/2005