Provider First Line Business Practice Location Address:
850 N 11TH 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:
19123-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-769-1100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2006