Provider First Line Business Practice Location Address:
1116 23RD ST S
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:
35205-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-5422
Provider Business Practice Location Address Fax Number:
205-933-6013
Provider Enumeration Date:
08/16/2007