Provider First Line Business Practice Location Address:
2000 GRANT AVE STE 201
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:
19115-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-464-6104
Provider Business Practice Location Address Fax Number:
215-464-9104
Provider Enumeration Date:
06/08/2006