Provider First Line Business Practice Location Address:
619 SOUTH 19TH STREET - JT 3N
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:
35249-6830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-857-7477
Provider Business Practice Location Address Fax Number:
205-975-9262
Provider Enumeration Date:
07/03/2008