Provider First Line Business Practice Location Address:
1900 N. 20TH STREET
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-2936
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006