Provider First Line Business Practice Location Address:
1700 N. BROAD ST.
Provider Second Line Business Practice Location Address:
TEMPLE UNIVERSITY - ATHLETIC TRAINING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-204-7444
Provider Business Practice Location Address Fax Number:
215-204-2133
Provider Enumeration Date:
09/10/2007