Provider First Line Business Practice Location Address:
452 W ALLEGHENY 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:
19133-3639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-2500
Provider Business Practice Location Address Fax Number:
215-291-2587
Provider Enumeration Date:
11/22/2005