Provider First Line Business Practice Location Address:
121 NORTH TENTH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-1304
Provider Business Practice Location Address Fax Number:
215-923-5730
Provider Enumeration Date:
05/02/2007