Provider First Line Business Practice Location Address:
34TH ST. & CIVIC CENTER BLVD.,
Provider Second Line Business Practice Location Address:
ROOM 9NW55
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-2437
Provider Business Practice Location Address Fax Number:
215-590-2768
Provider Enumeration Date:
07/21/2009