Provider First Line Business Practice Location Address:
1025 N 66TH 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:
19151-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-477-8800
Provider Business Practice Location Address Fax Number:
215-477-8800
Provider Enumeration Date:
10/12/2005