Provider First Line Business Practice Location Address:
800 MCKEAN 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:
19148-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-468-0622
Provider Business Practice Location Address Fax Number:
215-468-0175
Provider Enumeration Date:
09/16/2006