Provider First Line Business Practice Location Address:
250 SOUTH PETERSON AVE
Provider Second Line Business Practice Location Address:
MALCOLMS DRUG STORE INC
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31533-5237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-384-1989
Provider Business Practice Location Address Fax Number:
912-383-7109
Provider Enumeration Date:
08/31/2006