Provider First Line Business Practice Location Address:
2027 CHESTNUT 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:
19103-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-557-8555
Provider Business Practice Location Address Fax Number:
215-557-9051
Provider Enumeration Date:
02/22/2010