Provider First Line Business Practice Location Address:
MEDICAL TOWER 255 SO. 17 STREET
Provider Second Line Business Practice Location Address:
SUITE 2708
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-735-2444
Provider Business Practice Location Address Fax Number:
215-735-2447
Provider Enumeration Date:
02/20/2007