Provider First Line Business Practice Location Address:
139 3RD AVE W
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:
35204-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-254-8555
Provider Business Practice Location Address Fax Number:
205-254-8744
Provider Enumeration Date:
04/20/2007