Provider First Line Business Practice Location Address:
NP 5240 619 19TH 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:
35249-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-996-9484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2013