Provider First Line Business Practice Location Address:
255 SOUTH 17TH STREET #2708
Provider Second Line Business Practice Location Address:
THE MEDICAL TOWER BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-6228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-7207
Provider Business Practice Location Address Fax Number:
215-735-2447
Provider Enumeration Date:
05/05/2006