Provider First Line Business Practice Location Address:
220-224 SOUTH BROAD ST.
Provider Second Line Business Practice Location Address:
8TH FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-670-2225
Provider Business Practice Location Address Fax Number:
215-670-9662
Provider Enumeration Date:
09/14/2006