Provider First Line Business Practice Location Address:
500 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:
19147-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-551-6838
Provider Business Practice Location Address Fax Number:
215-551-6718
Provider Enumeration Date:
06/05/2007