Provider First Line Business Practice Location Address:
1316 W ONTARIO ST
Provider Second Line Business Practice Location Address:
JONES HALL, 10TH FLOOR, RM. 1001
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-5435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2011