Provider First Line Business Practice Location Address:
2401 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
4A5
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-236-0366
Provider Business Practice Location Address Fax Number:
215-236-2787
Provider Enumeration Date:
02/08/2012