Provider First Line Business Practice Location Address:
900 N MARSHALL ST
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:
19123-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-232-9727
Provider Business Practice Location Address Fax Number:
215-232-4542
Provider Enumeration Date:
09/20/2013