Provider First Line Business Practice Location Address:
3451 N 6TH 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:
19140-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-454-2157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2007