Provider First Line Business Practice Location Address:
500 S. BROAD 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:
19146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-6513
Provider Business Practice Location Address Fax Number:
215-790-1651
Provider Enumeration Date:
12/01/2006