Provider First Line Business Practice Location Address:
201 N 9TH ST STE A
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:
19107-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-627-2229
Provider Business Practice Location Address Fax Number:
215-627-2229
Provider Enumeration Date:
10/13/2005