Provider First Line Business Practice Location Address:
BROAD AND MONTGOMERY STREET
Provider Second Line Business Practice Location Address:
TEMPLE UNIVERSITY- MCGONIGLE HALL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-204-3687
Provider Business Practice Location Address Fax Number:
215-204-2133
Provider Enumeration Date:
06/07/2007