Provider First Line Business Practice Location Address:
142 S 52ND ST STE 201
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:
19139-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-4000
Provider Business Practice Location Address Fax Number:
215-471-4001
Provider Enumeration Date:
01/14/2026