Provider First Line Business Practice Location Address:
120 S 30TH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-222-2466
Provider Business Practice Location Address Fax Number:
215-222-2462
Provider Enumeration Date:
05/11/2007