Provider First Line Business Practice Location Address:
1720 SOUTH BROAD STREET
Provider Second Line Business Practice Location Address:
CITY OF PHILADELPHIA HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-1811
Provider Business Practice Location Address Fax Number:
215-683-1815
Provider Enumeration Date:
12/15/2006