Provider First Line Business Practice Location Address:
555 S 43RD ST
Provider Second Line Business Practice Location Address:
HEALTH CARE CENTER 3
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-7522
Provider Business Practice Location Address Fax Number:
215-685-6848
Provider Enumeration Date:
08/24/2006