Provider First Line Business Practice Location Address:
301 SOUTH 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE 2-C
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-7444
Provider Business Practice Location Address Fax Number:
215-829-7674
Provider Enumeration Date:
07/23/2006