Provider First Line Business Practice Location Address:
1701 S 2ND 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:
19148-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-389-4148
Provider Business Practice Location Address Fax Number:
215-389-0296
Provider Enumeration Date:
02/02/2007