Provider First Line Business Practice Location Address:
2244 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:
19133-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-739-7400
Provider Business Practice Location Address Fax Number:
610-667-2794
Provider Enumeration Date:
01/11/2007