Provider First Line Business Practice Location Address:
1740 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-735-0505
Provider Business Practice Location Address Fax Number:
215-735-0577
Provider Enumeration Date:
10/14/2009