Provider First Line Business Practice Location Address:
100 E LEHIGH AVE
Provider Second Line Business Practice Location Address:
CHC 1
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-1866
Provider Business Practice Location Address Fax Number:
215-707-1876
Provider Enumeration Date:
12/01/2005