Provider First Line Business Practice Location Address:
111 NORTH 49TH STREET
Provider Second Line Business Practice Location Address:
KIRKBRIDE BUILDING ROOM 134
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-806-1211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2007