Provider First Line Business Practice Location Address:
1740 SOUTH ST.
Provider Second Line Business Practice Location Address:
SUITE #301
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-316-9157
Provider Business Practice Location Address Fax Number:
215-735-5690
Provider Enumeration Date:
09/27/2007