Provider First Line Business Practice Location Address:
309 S 13TH 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:
19107-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-893-4811
Provider Business Practice Location Address Fax Number:
215-893-4810
Provider Enumeration Date:
06/25/2005