Provider First Line Business Practice Location Address:
1309 DECATUR HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDENDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-631-1449
Provider Business Practice Location Address Fax Number:
205-608-0480
Provider Enumeration Date:
08/20/2006