Provider First Line Business Practice Location Address:
5518 NW 88TH ST
Provider Second Line Business Practice Location Address:
DRAKE PHARMACY
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50131-1782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-557-1810
Provider Business Practice Location Address Fax Number:
515-557-1809
Provider Enumeration Date:
08/29/2007