Provider First Line Business Practice Location Address:
3340 E. ANDY DEVINE
Provider Second Line Business Practice Location Address:
K-MART PHARMACY
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-757-3909
Provider Business Practice Location Address Fax Number:
928-757-1710
Provider Enumeration Date:
03/24/2010