Provider First Line Business Practice Location Address:
610 W KETTLEMAN LN
Provider Second Line Business Practice Location Address:
S-MART PHARMACY
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-339-9805
Provider Business Practice Location Address Fax Number:
209-334-2203
Provider Enumeration Date:
11/29/2005