Provider First Line Business Practice Location Address:
2230 S BROAD 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:
19145-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-3869
Provider Business Practice Location Address Fax Number:
215-755-3300
Provider Enumeration Date:
03/22/2006