Provider First Line Business Practice Location Address:
100 N 17TH STREET
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-985-3315
Provider Business Practice Location Address Fax Number:
215-985-9111
Provider Enumeration Date:
02/01/2008