Provider First Line Business Practice Location Address:
313 S 16TH ASTREET
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:
19102-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-732-8244
Provider Business Practice Location Address Fax Number:
215-732-8454
Provider Enumeration Date:
10/28/2011