Provider First Line Business Practice Location Address:
60 CHURCH STREET
Provider Second Line Business Practice Location Address:
CRESTLINE PHARMACY
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-871-0317
Provider Business Practice Location Address Fax Number:
205-871-9756
Provider Enumeration Date:
10/13/2006