Provider First Line Business Practice Location Address:
4190 CITY AVE
Provider Second Line Business Practice Location Address:
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE, RH226
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-468-0600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007