Provider First Line Business Practice Location Address:
17 SOUTH 20TH 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:
19103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-567-6870
Provider Business Practice Location Address Fax Number:
215-563-1930
Provider Enumeration Date:
12/14/2006