Provider First Line Business Practice Location Address:
117 S 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 1902
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-567-1377
Provider Business Practice Location Address Fax Number:
215-567-5314
Provider Enumeration Date:
02/07/2007