Provider First Line Business Practice Location Address:
14 S 3RD STREET
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-225-3056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2018