Provider First Line Business Practice Location Address:
132 S 10TH 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:
19107-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-4337
Provider Business Practice Location Address Fax Number:
215-955-2604
Provider Enumeration Date:
08/29/2007