Provider First Line Business Practice Location Address:
1550 PRATT ST
Provider Second Line Business Practice Location Address:
FL 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-686-8800
Provider Business Practice Location Address Fax Number:
267-686-8745
Provider Enumeration Date:
08/25/2015