Provider First Line Business Practice Location Address:
820 W THOMPSON 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:
19122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-827-2010
Provider Business Practice Location Address Fax Number:
215-232-1037
Provider Enumeration Date:
03/22/2007