Provider First Line Business Practice Location Address:
6218 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:
19120-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-548-1212
Provider Business Practice Location Address Fax Number:
215-927-3225
Provider Enumeration Date:
01/12/2007