Provider First Line Business Practice Location Address:
1401 S 4TH 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:
19147-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-465-1414
Provider Business Practice Location Address Fax Number:
215-465-6047
Provider Enumeration Date:
03/15/2007