Provider First Line Business Practice Location Address:
1301 S 3RD 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:
19147-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-467-2120
Provider Business Practice Location Address Fax Number:
215-467-3620
Provider Enumeration Date:
05/15/2008