Provider First Line Business Practice Location Address:
6201 N FRONT 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:
19120-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-2500
Provider Business Practice Location Address Fax Number:
215-224-4694
Provider Enumeration Date:
05/22/2007