Provider First Line Business Practice Location Address:
2120 SPRUCE 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:
19103-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-732-3720
Provider Business Practice Location Address Fax Number:
215-732-2543
Provider Enumeration Date:
04/07/2007