Provider First Line Business Practice Location Address:
113-131 WEST WYOMING AVE
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-329-1516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2011