Provider First Line Business Practice Location Address:
214 NORTH 4TH ST.
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-1163
Provider Business Practice Location Address Fax Number:
215-923-4032
Provider Enumeration Date:
06/15/2006