Provider First Line Business Practice Location Address:
HOUSE STAFF AFFAIRS, SUITE 2170, 111 S. 11TH STREET,
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:
19107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-2997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2019