Provider First Line Business Practice Location Address:
3200 27TH ST N
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35207-4554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-324-5132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2009