Provider First Line Business Practice Location Address:
633 TUSCALOOSA AVE SW
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:
35211-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-785-3159
Provider Business Practice Location Address Fax Number:
205-788-3656
Provider Enumeration Date:
10/21/2006