Provider First Line Business Practice Location Address:
215 21ST AVE S
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:
35205-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-323-6383
Provider Business Practice Location Address Fax Number:
205-323-0085
Provider Enumeration Date:
10/27/2006