Provider First Line Business Practice Location Address:
1700 AVENUE E 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:
35218-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-241-5240
Provider Business Practice Location Address Fax Number:
205-241-5299
Provider Enumeration Date:
06/10/2006