Provider First Line Business Practice Location Address:
215 N 9TH 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:
19107-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-6288
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2005