Provider First Line Business Practice Location Address:
2546 S BROAD ST
Provider Second Line Business Practice Location Address:
SHUNK ST ENTRANCE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-271-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006