Provider First Line Business Practice Location Address:
619 19TH ST S
Provider Second Line Business Practice Location Address:
ROOM-JT845
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-979-5882
Provider Business Practice Location Address Fax Number:
205-979-1248
Provider Enumeration Date:
01/20/2015