Provider First Line Business Practice Location Address:
2532 N BROAD 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:
19132-4013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-226-7860
Provider Business Practice Location Address Fax Number:
215-266-7869
Provider Enumeration Date:
12/11/2014