Provider First Line Business Practice Location Address:
301 GOVERNORS DRIVE
Provider Second Line Business Practice Location Address:
VA CBOC, UAB MEDICAL BUILDING
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-535-3100
Provider Business Practice Location Address Fax Number:
256-534-1580
Provider Enumeration Date:
07/27/2006