Provider First Line Business Practice Location Address:
701 S. 19TH ST.
Provider Second Line Business Practice Location Address:
LHR 112
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-520-5237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2019