Provider First Line Business Practice Location Address:
1028 28TH ST 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:
35205-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-545-7075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2026