Provider First Line Business Practice Location Address:
160 E ERIE AVE
Provider Second Line Business Practice Location Address:
SUITE 3311
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-3871
Provider Business Practice Location Address Fax Number:
215-492-8119
Provider Enumeration Date:
11/07/2005