Provider First Line Business Practice Location Address:
2301 S 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:
19148-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-952-9323
Provider Business Practice Location Address Fax Number:
215-952-1246
Provider Enumeration Date:
10/03/2005