Provider First Line Business Practice Location Address:
27 SO 11TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-6516
Provider Business Practice Location Address Fax Number:
215-922-3925
Provider Enumeration Date:
01/31/2007