Provider First Line Business Practice Location Address:
401 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 279
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-488-4480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2008