Provider First Line Business Practice Location Address:
1300 MADISON AVE S
Provider Second Line Business Practice Location Address:
KMART PHARMACY
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31533-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-384-0144
Provider Business Practice Location Address Fax Number:
912-384-0252
Provider Enumeration Date:
08/31/2012