Provider First Line Business Practice Location Address:
1318 W CLEARFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19132-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-340-9430
Provider Business Practice Location Address Fax Number:
888-225-0529
Provider Enumeration Date:
02/01/2007