Provider First Line Business Practice Location Address:
3041 ENSLEY 5 POINTS W AVE STE D
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:
35208-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-785-4223
Provider Business Practice Location Address Fax Number:
205-785-4225
Provider Enumeration Date:
11/01/2006