Provider First Line Business Practice Location Address:
5933 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-549-5000
Provider Business Practice Location Address Fax Number:
215-549-9558
Provider Enumeration Date:
05/26/2006