Provider First Line Business Practice Location Address:
2514 NORTH BROAD 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:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-899-8915
Provider Business Practice Location Address Fax Number:
215-226-1278
Provider Enumeration Date:
06/26/2015