Provider First Line Business Practice Location Address:
240 MEDICAL OFFICE BUILDING
Provider Second Line Business Practice Location Address:
51 N. 39TH STREET
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-8730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2016