Provider First Line Business Practice Location Address:
325 S 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-6533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-985-1947
Provider Business Practice Location Address Fax Number:
215-985-3633
Provider Enumeration Date:
07/08/2006