Provider First Line Business Practice Location Address:
1000 WEST G STREET
Provider Second Line Business Practice Location Address:
BURGIE DRUGSTORE
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-542-4622
Provider Business Practice Location Address Fax Number:
423-542-2564
Provider Enumeration Date:
09/28/2006