Provider First Line Business Practice Location Address:
210 N 9TH 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:
19107-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-337-1534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2007