Provider First Line Business Practice Location Address:
29 10 NORTH 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-2392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2007