Provider First Line Business Practice Location Address:
2322 E NORRIS 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:
19125-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-739-6100
Provider Business Practice Location Address Fax Number:
215-634-2130
Provider Enumeration Date:
01/17/2007