Provider First Line Business Practice Location Address:
6701 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19126-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-276-3922
Provider Business Practice Location Address Fax Number:
215-924-4485
Provider Enumeration Date:
05/17/2006