Provider First Line Business Practice Location Address:
2014 MORRIS AVE
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:
35203-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-328-1744
Provider Business Practice Location Address Fax Number:
205-328-4270
Provider Enumeration Date:
10/05/2009