Provider First Line Business Practice Location Address:
1318 20TH STREET SOUTH
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-5604
Provider Business Practice Location Address Fax Number:
205-933-5172
Provider Enumeration Date:
09/14/2006