Provider First Line Business Practice Location Address:
215 CHURCH ST.
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-802-1998
Provider Business Practice Location Address Fax Number:
800-974-4241
Provider Enumeration Date:
03/04/2011