Provider First Line Business Practice Location Address:
2100 NORTH 49TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-2698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-877-1565
Provider Business Practice Location Address Fax Number:
215-877-7222
Provider Enumeration Date:
05/02/2011