Provider First Line Business Practice Location Address:
5925 N 5TH 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:
19120-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-1500
Provider Business Practice Location Address Fax Number:
215-224-6500
Provider Enumeration Date:
08/18/2006