Provider First Line Business Practice Location Address:
3801 FILBERT STREET
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-8978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2007