Provider First Line Business Practice Location Address:
1214 MOORE 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:
19148-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-271-0318
Provider Business Practice Location Address Fax Number:
215-271-0319
Provider Enumeration Date:
01/10/2007