Provider First Line Business Practice Location Address:
6900 6TH AVE S
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:
35212-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-836-0049
Provider Business Practice Location Address Fax Number:
205-836-3349
Provider Enumeration Date:
07/18/2007