Provider First Line Business Practice Location Address:
461 N 3RD ST
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-940-2980
Provider Business Practice Location Address Fax Number:
215-940-8264
Provider Enumeration Date:
08/09/2006