Provider First Line Business Practice Location Address:
241 S 6TH 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:
19106-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-1466
Provider Business Practice Location Address Fax Number:
215-829-0820
Provider Enumeration Date:
02/11/2006