Provider First Line Business Practice Location Address:
13521 OLD HIGHWAY 280
Provider Second Line Business Practice Location Address:
STE. 201B
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-877-2663
Provider Business Practice Location Address Fax Number:
205-874-9622
Provider Enumeration Date:
11/18/2015