Provider First Line Business Practice Location Address:
700 SPRUCE ST
Provider Second Line Business Practice Location Address:
STE. 507
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-8455
Provider Business Practice Location Address Fax Number:
215-829-8431
Provider Enumeration Date:
11/16/2006