Provider First Line Business Practice Location Address:
3600 SPRUCE ST
Provider Second Line Business Practice Location Address:
839 WEST GATES
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-614-0871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2013