Provider First Line Business Practice Location Address:
219 N BROAD ST FL 10
Provider Second Line Business Practice Location Address:
PHILADELPHIA EAR NOSE & THROAT ASSOCIATES
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-762-5530
Provider Business Practice Location Address Fax Number:
215-762-5540
Provider Enumeration Date:
09/21/2011