Provider First Line Business Practice Location Address:
245 S 8TH ST
Provider Second Line Business Practice Location Address:
OFFICE 140
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-7319
Provider Business Practice Location Address Fax Number:
215-829-7315
Provider Enumeration Date:
06/26/2007