Provider First Line Business Practice Location Address:
2144 S. BROAD 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:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-339-0551
Provider Business Practice Location Address Fax Number:
215-339-5248
Provider Enumeration Date:
12/12/2006