Provider First Line Business Practice Location Address:
2437 S 24TH ST
Provider Second Line Business Practice Location Address:
SUITE E S PHILADELPHIA SHOPPING CTR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-468-3469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2007