Provider First Line Business Practice Location Address:
2110 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:
19103-6596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-537-4900
Provider Business Practice Location Address Fax Number:
215-546-9518
Provider Enumeration Date:
06/17/2005