Provider First Line Business Practice Location Address:
1308 S 8TH STREET
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:
19147-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-755-4534
Provider Business Practice Location Address Fax Number:
215-755-4524
Provider Enumeration Date:
06/16/2006