Provider First Line Business Practice Location Address:
432 N 6TH 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:
19123-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-2400
Provider Business Practice Location Address Fax Number:
215-925-9162
Provider Enumeration Date:
12/15/2009