Provider First Line Business Practice Location Address:
250 PHILIP PL
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:
19106-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-4175
Provider Business Practice Location Address Fax Number:
215-925-8448
Provider Enumeration Date:
11/01/2007