Provider First Line Business Practice Location Address:
1715 11TH AVE S STE C
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:
35205-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-251-6928
Provider Business Practice Location Address Fax Number:
205-251-6968
Provider Enumeration Date:
05/24/2007