Provider First Line Business Practice Location Address:
525 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 592
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-1622
Provider Business Practice Location Address Fax Number:
215-334-4441
Provider Enumeration Date:
01/05/2007