Provider First Line Business Practice Location Address:
700 UNIVERSITY BLVD E RM 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35487-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-348-7131
Provider Business Practice Location Address Fax Number:
205-348-1845
Provider Enumeration Date:
01/31/2007