Provider First Line Business Practice Location Address:
3601 PACIFIC AVE
Provider Second Line Business Practice Location Address:
T. J. LONG SCHOOL OF PHARMACY
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95211-0110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-946-2396
Provider Business Practice Location Address Fax Number:
209-932-4038
Provider Enumeration Date:
09/14/2012