Provider First Line Business Practice Location Address: 
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
    Provider Second Line Business Practice Location Address: 
930 20TH STREET SOUTH
    Provider Business Practice Location Address City Name: 
BIRMINGHAM
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
35205
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
251-622-2496
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/10/2023