Provider First Line Business Practice Location Address:
1200 WASHINGTON AVE
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:
19147-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-999-6969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007