Provider First Line Business Practice Location Address:
245 S 8TH 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:
19106-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-796-4640
Provider Business Practice Location Address Fax Number:
609-770-7792
Provider Enumeration Date:
01/19/2007