Provider First Line Business Practice Location Address:
255 S 16TH 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:
19102-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-4331
Provider Business Practice Location Address Fax Number:
215-545-5774
Provider Enumeration Date:
07/21/2008