Provider First Line Business Practice Location Address:
210E BARTOW ARENA
Provider Second Line Business Practice Location Address:
617 13TH ST SO
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-9040
Provider Business Practice Location Address Fax Number:
205-975-7286
Provider Enumeration Date:
07/18/2006