Provider First Line Business Practice Location Address:
1500 SPRUCE 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:
19102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-790-3290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006