Provider First Line Business Practice Location Address:
1100 HWY 13 NORTH
Provider Second Line Business Practice Location Address:
FREDS PHARMACY
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-736-3394
Provider Business Practice Location Address Fax Number:
601-736-3499
Provider Enumeration Date:
09/28/2010