Provider First Line Business Practice Location Address:
2302 BROWN RD
Provider Second Line Business Practice Location Address:
CENTINELA STATE PRISON PHARMACY
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-337-7624
Provider Business Practice Location Address Fax Number:
760-482-3006
Provider Enumeration Date:
02/20/2014