Provider First Line Business Practice Location Address:
133 W HUNTING PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 300A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-324-0600
Provider Business Practice Location Address Fax Number:
215-324-2795
Provider Enumeration Date:
12/30/2005