Provider First Line Business Practice Location Address:
9846 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
TARGET PHARMACY STORE T1485
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-9682
Provider Business Practice Location Address Fax Number:
619-449-9682
Provider Enumeration Date:
06/06/2011