Provider First Line Business Practice Location Address:
2114 10TH AVE SOUTH
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:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-325-4144
Provider Business Practice Location Address Fax Number:
305-323-6133
Provider Enumeration Date:
10/25/2006