Provider First Line Business Practice Location Address:
530 S 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-808-8919
Provider Business Practice Location Address Fax Number:
215-808-8919
Provider Enumeration Date:
10/24/2011