Provider First Line Business Practice Location Address:
501-7 SOUTH 12TH 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:
19147-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-2100
Provider Business Practice Location Address Fax Number:
215-923-1012
Provider Enumeration Date:
10/01/2007