Provider First Line Business Practice Location Address:
215 SOUTH BROAD ST.
Provider Second Line Business Practice Location Address:
RITEAID PHARMACY STORE 1365
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-735-3593
Provider Business Practice Location Address Fax Number:
215-790-0146
Provider Enumeration Date:
07/22/2010