Provider First Line Business Practice Location Address:
3400 SPRUCE ST.
Provider Second Line Business Practice Location Address:
3 SILVERSTEIN BLDG., SUITE D
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-6932
Provider Business Practice Location Address Fax Number:
617-662-7899
Provider Enumeration Date:
12/05/2005