Provider First Line Business Practice Location Address:
4946 N 5TH ST
Provider Second Line Business Practice Location Address:
1ST FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-924-4142
Provider Business Practice Location Address Fax Number:
215-924-4143
Provider Enumeration Date:
05/25/2007