Provider First Line Business Practice Location Address:
13521 OLD HIGHWAY 280 STE 225
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:
35242-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-773-1130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006