Provider First Line Business Practice Location Address: 
809 UNIVERSITY BLVD E
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF PATHOLOGY
    Provider Business Practice Location Address City Name: 
TUSCALOOSA
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
35401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-759-7484
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/10/2015