Provider First Line Business Practice Location Address:
325 12TH ST SW
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:
35211-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-722-4580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2026