Provider First Line Business Practice Location Address:
SCPA GI
Provider Second Line Business Practice Location Address:
ERIE AVE AT FRONT ST
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-6778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007