Provider First Line Business Practice Location Address:
801 SPRUCE ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-6741
Provider Business Practice Location Address Fax Number:
215-829-7547
Provider Enumeration Date:
02/21/2006