Provider First Line Business Practice Location Address:
34TH ST AND CIVIC CTR BLVD
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:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-1000
Provider Business Practice Location Address Fax Number:
215-481-8795
Provider Enumeration Date:
01/03/2008