Provider First Line Business Practice Location Address:
244 E GIRARD AVE
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:
19125-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-739-2543
Provider Business Practice Location Address Fax Number:
215-739-7239
Provider Enumeration Date:
10/11/2006