Provider First Line Business Practice Location Address:
3263 N FRONT STREET
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:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-426-1077
Provider Business Practice Location Address Fax Number:
215-429-1086
Provider Enumeration Date:
07/01/2008