Provider First Line Business Practice Location Address:
1029 35TH ST WEST ENSLEY
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:
35216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-781-3681
Provider Business Practice Location Address Fax Number:
205-781-3682
Provider Enumeration Date:
05/15/2007