Provider First Line Business Practice Location Address:
3601 A STREET
Provider Second Line Business Practice Location Address:
SUITE 2205
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-8915
Provider Business Practice Location Address Fax Number:
215-427-4603
Provider Enumeration Date:
12/27/2007