Provider First Line Business Practice Location Address:
1625 12TH 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:
35205-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-639-2450
Provider Business Practice Location Address Fax Number:
205-588-0754
Provider Enumeration Date:
07/24/2009