Provider First Line Business Practice Location Address:
RESIDENCY PROGRAM OFC
Provider Second Line Business Practice Location Address:
1922 7TH AVENUE SOUTH, 217 KRACKE BUILDING, UAB
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2015