Provider First Line Business Practice Location Address:
417 CALLOWHILL 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:
19123-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-600-3633
Provider Business Practice Location Address Fax Number:
215-600-3634
Provider Enumeration Date:
10/17/2012