Provider First Line Business Practice Location Address:
1812 28TH AVE S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-879-8861
Provider Business Practice Location Address Fax Number:
205-879-8227
Provider Enumeration Date:
03/10/2008