Provider First Line Business Practice Location Address:
233 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-755-6626
Provider Business Practice Location Address Fax Number:
215-467-7151
Provider Enumeration Date:
02/03/2007