Provider First Line Business Practice Location Address:
ZONE D (AMBULATORY CARE CENTER, 5103, 3401 N BROAD ST 5
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:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-836-7536
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2014