Provider First Line Business Practice Location Address:
1414 S 5TH 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:
19147-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-339-0991
Provider Business Practice Location Address Fax Number:
215-782-8070
Provider Enumeration Date:
07/25/2007