Provider First Line Business Practice Location Address:
900 E HOWELL 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:
19149-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-831-3050
Provider Business Practice Location Address Fax Number:
215-831-3065
Provider Enumeration Date:
09/27/2010