Provider First Line Business Practice Location Address:
142 S 52ND 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:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-474-4615
Provider Business Practice Location Address Fax Number:
215-476-9821
Provider Enumeration Date:
07/21/2006