Provider First Line Business Practice Location Address:
1515 UNIVERSITY BLVD
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:
35401-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-758-2225
Provider Business Practice Location Address Fax Number:
205-758-2257
Provider Enumeration Date:
10/25/2005