Provider First Line Business Practice Location Address:
604 S 10TH ST
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:
19147-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-4322
Provider Business Practice Location Address Fax Number:
215-928-1274
Provider Enumeration Date:
05/16/2006