Provider First Line Business Practice Location Address:
2000 GRANT AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-969-3944
Provider Business Practice Location Address Fax Number:
215-969-3886
Provider Enumeration Date:
07/11/2006