Provider First Line Business Practice Location Address: 
227 1ST ST N STE A
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ALABASTER
    Provider Business Practice Location Address State Name: 
AL
    Provider Business Practice Location Address Postal Code: 
35007-8767
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-663-3224
    Provider Business Practice Location Address Fax Number: 
205-663-3416
    Provider Enumeration Date: 
10/17/2006