Provider First Line Business Practice Location Address: 
1720 UNIVERSITY BLVD
    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: 
35294-1010
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
205-325-8100
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/28/2011