Provider First Line Business Practice Location Address:
514 S 4TH STREET
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:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-4274
Provider Business Practice Location Address Fax Number:
215-922-2715
Provider Enumeration Date:
03/13/2007