Provider First Line Business Practice Location Address:
51 N. 39TH STREET
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING, 1ST FLOOR SUITE 120
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-7320
Provider Business Practice Location Address Fax Number:
215-243-4605
Provider Enumeration Date:
10/06/2005