Provider First Line Business Practice Location Address:
610 BARNES 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:
19128-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-3200
Provider Business Practice Location Address Fax Number:
215-483-4665
Provider Enumeration Date:
05/18/2006