Provider First Line Business Practice Location Address:
1504 HOSPITAL STREET
Provider Second Line Business Practice Location Address:
PREMIER MEDICAL CLINIC
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-378-9929
Provider Business Practice Location Address Fax Number:
662-378-9926
Provider Enumeration Date:
11/06/2006