Provider First Line Business Practice Location Address:
1228 N FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 136, ADC BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-787-2365
Provider Business Practice Location Address Fax Number:
215-787-2345
Provider Enumeration Date:
05/11/2007