Provider First Line Business Practice Location Address:
3400 SPRUCE STREET
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:
19104-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-6503
Provider Business Practice Location Address Fax Number:
215-349-5910
Provider Enumeration Date:
04/05/2016