Provider First Line Business Practice Location Address:
1400 E MOUNT PLEASANT AVE
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:
19150-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-242-2200
Provider Business Practice Location Address Fax Number:
215-242-2200
Provider Enumeration Date:
03/05/2007