Provider First Line Business Practice Location Address:
201 N 3RD 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:
19106-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-309-3119
Provider Business Practice Location Address Fax Number:
215-309-3143
Provider Enumeration Date:
04/16/2015