Provider First Line Business Practice Location Address:
801 N 2ND 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:
19123-3090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-296-1010
Provider Business Practice Location Address Fax Number:
267-296-1012
Provider Enumeration Date:
12/15/2010