Provider First Line Business Practice Location Address:
501 SOUTH 4TH 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:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-7299
Provider Business Practice Location Address Fax Number:
215-925-4108
Provider Enumeration Date:
07/11/2006