Provider First Line Business Practice Location Address:
1745 SOUTH 8TH ST
Provider Second Line Business Practice Location Address:
WINN DIXIE PHARMACY
Provider Business Practice Location Address City Name:
FERNANDINA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-277-6664
Provider Business Practice Location Address Fax Number:
904-277-1501
Provider Enumeration Date:
11/20/2006