Provider First Line Business Practice Location Address:
6555 GREENE ST STE 3
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:
19119-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-848-0500
Provider Business Practice Location Address Fax Number:
215-848-0510
Provider Enumeration Date:
08/23/2011