Provider First Line Business Practice Location Address:
1630 WALNUT 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:
19103-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-8100
Provider Business Practice Location Address Fax Number:
215-546-6120
Provider Enumeration Date:
01/03/2007