Provider First Line Business Practice Location Address:
1300 E TULPEHOCKEN 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:
19138-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-924-6322
Provider Business Practice Location Address Fax Number:
215-924-5531
Provider Enumeration Date:
03/14/2007