Provider First Line Business Practice Location Address:
500 S BROAD ST
Provider Second Line Business Practice Location Address:
AMBULATORY HEALTH SERVICES
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-6792
Provider Business Practice Location Address Fax Number:
215-685-6848
Provider Enumeration Date:
01/16/2009