Provider First Line Business Practice Location Address:
1900 N 20TH ST
Provider Second Line Business Practice Location Address:
HEALTH CENTER #5
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19121-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-6767
Provider Business Practice Location Address Fax Number:
215-685-6625
Provider Enumeration Date:
09/18/2008