Provider First Line Business Practice Location Address:
1325 S 33RD ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-2761
Provider Business Practice Location Address Fax Number:
215-472-6093
Provider Enumeration Date:
10/19/2015