Provider First Line Business Practice Location Address:
6701 CALLOWHILL 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:
19151-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-476-6471
Provider Business Practice Location Address Fax Number:
215-476-0431
Provider Enumeration Date:
05/22/2008