Provider First Line Business Practice Location Address:
5002 SPRUCE STREET
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:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-747-1522
Provider Business Practice Location Address Fax Number:
215-472-8001
Provider Enumeration Date:
03/22/2007