Provider First Line Business Practice Location Address:
SRC 385 619 19TH ST S
Provider Second Line Business Practice Location Address:
R385 SPAIN REHABILITATION CENTER 1717 6TH AVENUE SOUTH
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-975-4922
Provider Business Practice Location Address Fax Number:
205-934-4351
Provider Enumeration Date:
10/28/2014