Provider First Line Business Practice Location Address:
148 N 8TH STREET
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:
19107-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-625-5341
Provider Business Practice Location Address Fax Number:
215-629-0716
Provider Enumeration Date:
06/30/2009