Provider First Line Business Practice Location Address:
299 S 8TH 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:
19106-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-3409
Provider Business Practice Location Address Fax Number:
215-925-9749
Provider Enumeration Date:
11/14/2006