Provider First Line Business Practice Location Address:
120 S 30TH ST
Provider Second Line Business Practice Location Address:
IST DIVISION
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-386-3838
Provider Business Practice Location Address Fax Number:
215-438-4872
Provider Enumeration Date:
11/01/2006