Provider First Line Business Practice Location Address:
3322 N BROAD ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-4600
Provider Business Practice Location Address Fax Number:
215-707-4034
Provider Enumeration Date:
06/21/2006