Provider First Line Business Practice Location Address:
150 MAIN STREET PHARMACY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT VERNON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-256-0475
Provider Business Practice Location Address Fax Number:
606-256-0421
Provider Enumeration Date:
11/13/2007