Provider First Line Business Practice Location Address:
619 SOUTH 19TH STREET, WP 220
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:
35233-7331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-613-5069
Provider Business Practice Location Address Fax Number:
913-934-4060
Provider Enumeration Date:
06/20/2007