Provider First Line Business Practice Location Address:
1306-10 UNITY STREET
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:
19124-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-342-3111
Provider Business Practice Location Address Fax Number:
215-744-8067
Provider Enumeration Date:
12/20/2005