Provider First Line Business Practice Location Address:
1821 20TH STREET ENSLEY
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:
35218-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-785-3101
Provider Business Practice Location Address Fax Number:
205-783-9305
Provider Enumeration Date:
04/14/2006