Provider First Line Business Practice Location Address:
213 N 4TH ST # 217
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:
19106-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-8033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006