Provider First Line Business Practice Location Address:
1400 S. 5TH 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:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-467-3515
Provider Business Practice Location Address Fax Number:
215-467-0038
Provider Enumeration Date:
11/02/2005