Provider First Line Business Practice Location Address:
908 20TH ST SOUTH
Provider Second Line Business Practice Location Address:
COMMUNITY CARE BUILDING (CCB), 4TH FLOOR
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-3476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2020