Provider First Line Business Practice Location Address:
3720 WALNUT ST
Provider Second Line Business Practice Location Address:
SOLOMON LAB BLUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-746-2194
Provider Business Practice Location Address Fax Number:
215-898-7301
Provider Enumeration Date:
08/06/2008