Provider First Line Business Practice Location Address: 
FOOD CITY PHARMACY #654
    Provider Second Line Business Practice Location Address: 
507 SOUTH CHARLES SEVIERS BLVD
    Provider Business Practice Location Address City Name: 
CLINTON
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
37716
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
865-457-5259
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/06/2021