Provider First Line Business Practice Location Address:
400 W ALLEGHENY AVENUE
Provider Second Line Business Practice Location Address:
UNITE B-5
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-207-0522
Provider Business Practice Location Address Fax Number:
215-291-2582
Provider Enumeration Date:
06/03/2010