Provider First Line Business Practice Location Address:
992 N 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:
19123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-995-8326
Provider Business Practice Location Address Fax Number:
267-457-3312
Provider Enumeration Date:
10/23/2010