Provider First Line Business Practice Location Address:
4910 BROADWAY
Provider Second Line Business Practice Location Address:
RITE AID 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:
10034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-569-2512
Provider Business Practice Location Address Fax Number:
646-796-9839
Provider Enumeration Date:
04/26/2007