Provider First Line Business Practice Location Address:
2637-45 N. 5TH STREET
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:
19133-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-0550
Provider Business Practice Location Address Fax Number:
215-291-0566
Provider Enumeration Date:
02/02/2007