Provider First Line Business Practice Location Address:
220 S 16TH ST
Provider Second Line Business Practice Location Address:
#900
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-5455
Provider Business Practice Location Address Fax Number:
215-545-4107
Provider Enumeration Date:
04/23/2007