Provider First Line Business Practice Location Address:
214 E GORGAS LN
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:
19119-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-3153
Provider Business Practice Location Address Fax Number:
215-849-1112
Provider Enumeration Date:
01/05/2009