Provider First Line Business Practice Location Address:
1000 24TH ST S
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:
35205-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-916-0123
Provider Business Practice Location Address Fax Number:
205-916-0878
Provider Enumeration Date:
11/16/2009