Provider First Line Business Practice Location Address:
900 S. 49TH STREET (2ND FL FR)
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:
19143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-475-0720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2022