Provider First Line Business Practice Location Address:
3400 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
MAIN BLDG - 5TH FLR - ROOM 5130
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-2266
Provider Business Practice Location Address Fax Number:
215-590-2171
Provider Enumeration Date:
01/18/2007