Provider First Line Business Practice Location Address:
1518 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-546-5900
Provider Business Practice Location Address Fax Number:
215-546-0530
Provider Enumeration Date:
08/23/2006