Provider First Line Business Practice Location Address:
639-41 CATHARINE ST.
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-351-5444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2006