Provider First Line Business Practice Location Address:
100 AVE. W PRATT CITY
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:
35214-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-798-1697
Provider Business Practice Location Address Fax Number:
205-791-0165
Provider Enumeration Date:
07/05/2006