Provider First Line Business Practice Location Address:
2417 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-462-7228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007