Provider First Line Business Practice Location Address:
4102 CHURCH AVE
Provider Second Line Business Practice Location Address:
RITE AID OF NEW YORK, INC #3864
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-940-1579
Provider Business Practice Location Address Fax Number:
718-469-7283
Provider Enumeration Date:
12/16/2007