Provider First Line Business Practice Location Address:
1740 SOUTH ST
Provider Second Line Business Practice Location Address:
STE 300
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:
215-732-0876
Provider Business Practice Location Address Fax Number:
215-732-4162
Provider Enumeration Date:
05/02/2006