Provider First Line Business Practice Location Address:
247 N 2ND ST
Provider Second Line Business Practice Location Address:
1L
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-475-3105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2010