Provider First Line Business Practice Location Address:
714 REED 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:
19147-5739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-627-1610
Provider Business Practice Location Address Fax Number:
267-514-2990
Provider Enumeration Date:
07/19/2005