Provider First Line Business Practice Location Address:
1641 N FRANKLIN 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:
19122-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-763-1875
Provider Business Practice Location Address Fax Number:
215-235-6897
Provider Enumeration Date:
11/30/2006