Provider First Line Business Practice Location Address:
525 NHB
Provider Second Line Business Practice Location Address:
619 SO 19TH ST
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-996-2244
Provider Business Practice Location Address Fax Number:
205-996-2254
Provider Enumeration Date:
08/08/2006