Provider First Line Business Practice Location Address:
900 S 48H STREET
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:
19143-3587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-439-7629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2014