Provider First Line Business Practice Location Address:
2400 E CUMBERLAND 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:
19125-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-423-9930
Provider Business Practice Location Address Fax Number:
215-425-2881
Provider Enumeration Date:
01/17/2007