Provider First Line Business Practice Location Address:
3537 ELLIS AVE SW
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:
35221-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-249-3242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2019