Provider First Line Business Practice Location Address:
216 WEST SOMERSET STREET
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-763-8870
Provider Business Practice Location Address Fax Number:
215-291-9153
Provider Enumeration Date:
02/27/2007