Provider First Line Business Practice Location Address:
1107 E PALMER ST
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:
19125-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-822-0451
Provider Business Practice Location Address Fax Number:
609-581-7726
Provider Enumeration Date:
03/27/2009