Provider First Line Business Practice Location Address:
1732 S BROAD ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-6162
Provider Business Practice Location Address Fax Number:
215-334-6180
Provider Enumeration Date:
07/14/2006