Provider First Line Business Practice Location Address:
926 ARCH ST
Provider Second Line Business Practice Location Address:
1 ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-232-0564
Provider Business Practice Location Address Fax Number:
610-270-0508
Provider Enumeration Date:
01/11/2007