Provider First Line Business Practice Location Address:
256 S 10TH 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:
19107-5750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-8099
Provider Business Practice Location Address Fax Number:
215-592-0295
Provider Enumeration Date:
11/13/2007