Provider First Line Business Practice Location Address:
2700 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-752-2246
Provider Business Practice Location Address Fax Number:
205-752-0430
Provider Enumeration Date:
08/05/2006