Provider First Line Business Practice Location Address:
120 S MACOUPIN
Provider Second Line Business Practice Location Address:
DIPPOLD DRUG CO INC
Provider Business Practice Location Address City Name:
GILLESPIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-839-9901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2006