Provider First Line Business Practice Location Address:
3550 MARKET ST
Provider Second Line Business Practice Location Address:
2ND FLOOR - PEDIATRIC DERMATOLOGY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-2169
Provider Business Practice Location Address Fax Number:
215-590-4948
Provider Enumeration Date:
10/16/2009