Provider First Line Business Practice Location Address:
125 S 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 1003
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-0331
Provider Business Practice Location Address Fax Number:
215-829-0338
Provider Enumeration Date:
01/04/2007