Provider First Line Business Practice Location Address:
417 N 8TH ST
Provider Second Line Business Practice Location Address:
FL 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-413-3050
Provider Business Practice Location Address Fax Number:
215-413-3056
Provider Enumeration Date:
09/12/2006