Provider First Line Business Practice Location Address:
522 S 2ND ST
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:
19147-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-625-9840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2010