Provider First Line Business Practice Location Address:
1539 PINE 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:
19102-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-732-2448
Provider Business Practice Location Address Fax Number:
215-732-7023
Provider Enumeration Date:
06/27/2006