Provider First Line Business Practice Location Address:
725 SOUTH BOULEVARD
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
FORTUNA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-725-9314
Provider Business Practice Location Address Fax Number:
707-725-4056
Provider Enumeration Date:
10/21/2008