Provider First Line Business Practice Location Address:
2724 N 5TH 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:
19133-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-739-8777
Provider Business Practice Location Address Fax Number:
215-739-9016
Provider Enumeration Date:
09/27/2006