Provider First Line Business Practice Location Address:
1700 UNIVERSITY BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-2985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-554-4196
Provider Business Practice Location Address Fax Number:
205-554-4198
Provider Enumeration Date:
09/28/2005