Provider First Line Business Practice Location Address:
1514 WOLF 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:
19145-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-463-3349
Provider Business Practice Location Address Fax Number:
215-463-0131
Provider Enumeration Date:
12/04/2006