Provider First Line Business Practice Location Address:
34TH ST AND CIVIC CENTER BLVD
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:
19104-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-3083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2012