Individual
MATTHEW RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
151 INDUSTRIAL DR, BIRMINGHAM, AL 35211-4445
(205) 949-1799
Mailing address
151 INDUSTRIAL DR, BIRMINGHAM, AL 35211-4445
(205) 949-1799
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4270
AL
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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