Provider First Line Business Practice Location Address:
5510 HIGHWAY 280 STE 211
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:
35242-6583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-201-1124
Provider Business Practice Location Address Fax Number:
205-987-0725
Provider Enumeration Date:
11/19/2010