Provider First Line Business Practice Location Address:
701 NORTH 63RD STREET
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:
19151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-477-0063
Provider Business Practice Location Address Fax Number:
215-477-3318
Provider Enumeration Date:
04/19/2007