Provider First Line Business Practice Location Address:
3615 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
ARC RM. 703E
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-426-7484
Provider Business Practice Location Address Fax Number:
215-590-5454
Provider Enumeration Date:
08/11/2010