Provider First Line Business Practice Location Address:
2923-25 E THOMPSON STREET
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:
19134-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-3981
Provider Business Practice Location Address Fax Number:
215-425-8083
Provider Enumeration Date:
01/17/2007