Provider First Line Business Practice Location Address:
3401 NORTH BROAD STREET 2ND FLOOR OUTPATIENT BUILDING
Provider Second Line Business Practice Location Address:
ZONE B243
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
445-235-9525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2022