Provider First Line Business Practice Location Address:
3400 SPRUCE STREET
Provider Second Line Business Practice Location Address:
843 WEST GATES
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-3202
Provider Business Practice Location Address Fax Number:
215-614-0914
Provider Enumeration Date:
07/07/2006