Provider First Line Business Practice Location Address:
2112 11TH AVE. SOUTH
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-328-0780
Provider Business Practice Location Address Fax Number:
205-328-0760
Provider Enumeration Date:
10/17/2006