Provider First Line Business Practice Location Address:
132 S. 10TH STREET
Provider Second Line Business Practice Location Address:
ROOM 285P
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-5588
Provider Business Practice Location Address Fax Number:
215-923-9068
Provider Enumeration Date:
10/12/2005