Provider First Line Business Practice Location Address:
1333 19TH STREET NORTH
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:
35324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-322-8288
Provider Business Practice Location Address Fax Number:
205-328-8786
Provider Enumeration Date:
09/29/2006