Provider First Line Business Practice Location Address:
1211 29TH 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:
35205-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-856-9041
Provider Business Practice Location Address Fax Number:
205-854-1694
Provider Enumeration Date:
04/27/2012