Provider First Line Business Practice Location Address:
51 N 39TH STREET, MEDICAL OFFICE BLDG
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:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-9494
Provider Business Practice Location Address Fax Number:
215-243-4681
Provider Enumeration Date:
10/27/2006