Provider First Line Business Practice Location Address:
600 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 18U-A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-4836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-678-4620
Provider Business Practice Location Address Fax Number:
215-701-2254
Provider Enumeration Date:
06/08/2010