Provider First Line Business Practice Location Address:
1720 2ND AVE S
Provider Second Line Business Practice Location Address:
SHPB 364
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-5982
Provider Business Practice Location Address Fax Number:
205-975-7787
Provider Enumeration Date:
08/15/2012