Provider First Line Business Practice Location Address:
3001 N 27TH 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:
19132-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-227-5038
Provider Business Practice Location Address Fax Number:
215-227-4777
Provider Enumeration Date:
04/10/2007