Provider First Line Business Practice Location Address:
200 N 16TH ST
Provider Second Line Business Practice Location Address:
MAIL CODE FP 1605
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-751-6275
Provider Business Practice Location Address Fax Number:
215-751-5252
Provider Enumeration Date:
05/19/2008