Provider First Line Business Practice Location Address:
3601 A 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:
19134-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-399-1773
Provider Business Practice Location Address Fax Number:
215-399-1776
Provider Enumeration Date:
07/21/2008