Provider First Line Business Practice Location Address:
4329 BROADWAY
Provider Second Line Business Practice Location Address:
BROADWAY PHARMACY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10033-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-740-8500
Provider Business Practice Location Address Fax Number:
212-740-9400
Provider Enumeration Date:
03/15/2010