Provider First Line Business Practice Location Address:
5950 VINE 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:
19139-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-474-5000
Provider Business Practice Location Address Fax Number:
210-528-5890
Provider Enumeration Date:
10/01/2007