Provider First Line Business Practice Location Address:
48 MEDICAL PARK EAST DRIVE
Provider Second Line Business Practice Location Address:
SUITE 153
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-838-3755
Provider Business Practice Location Address Fax Number:
205-838-3758
Provider Enumeration Date:
09/30/2011