Provider First Line Business Practice Location Address:
420 BAINBRIDGE 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:
19147-1568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-629-3837
Provider Business Practice Location Address Fax Number:
215-629-5531
Provider Enumeration Date:
11/21/2006