Provider First Line Business Practice Location Address:
1158 E HORTTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19150-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-910-3662
Provider Business Practice Location Address Fax Number:
215-247-6006
Provider Enumeration Date:
06/14/2007