Provider First Line Business Practice Location Address:
1800 SOUTH 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:
19146-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-273-7585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2013