Provider First Line Business Practice Location Address:
1234 MARKET ST
Provider Second Line Business Practice Location Address:
SEPTA MEDICAL DEPT.
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-580-7749
Provider Business Practice Location Address Fax Number:
215-580-3726
Provider Enumeration Date:
02/02/2006