Provider First Line Business Practice Location Address:
1200 20TH ST S
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-930-9797
Provider Business Practice Location Address Fax Number:
205-930-9799
Provider Enumeration Date:
11/09/2006