Provider First Line Business Practice Location Address:
1425 ARCH ST
Provider Second Line Business Practice Location Address:
YMCA BUILDING, FIRST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-557-9090
Provider Business Practice Location Address Fax Number:
215-557-9089
Provider Enumeration Date:
07/20/2006