Provider First Line Business Practice Location Address:
1306 SPRING GARDEN 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:
19123-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-413-8264
Provider Business Practice Location Address Fax Number:
215-413-8274
Provider Enumeration Date:
10/04/2010