Provider First Line Business Practice Location Address:
302 S 19TH 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:
19103-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-545-5606
Provider Business Practice Location Address Fax Number:
215-545-1692
Provider Enumeration Date:
12/01/2006