Provider First Line Business Practice Location Address:
1400 ENGLEWOOD 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:
19111-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-904-5965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007