Provider First Line Business Practice Location Address:
1310 ALFORD AVENUE
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:
35226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-822-7306
Provider Business Practice Location Address Fax Number:
205-822-0415
Provider Enumeration Date:
11/03/2006