Provider First Line Business Practice Location Address:
2653 VALLEYDALE RD
Provider Second Line Business Practice Location Address:
WINN-DIXIE PHARMACY 514
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-995-4960
Provider Business Practice Location Address Fax Number:
205-995-4965
Provider Enumeration Date:
09/13/2006