Provider First Line Business Practice Location Address:
1740 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-735-5600
Provider Business Practice Location Address Fax Number:
215-735-5690
Provider Enumeration Date:
02/10/2006