Provider First Line Business Practice Location Address:
5720 FIRST AVENUE SOUTH
Provider Second Line Business Practice Location Address:
BIRMINGHAM
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-380-9455
Provider Business Practice Location Address Fax Number:
205-380-9459
Provider Enumeration Date:
05/29/2012