Provider First Line Business Practice Location Address:
2860 N 5TH 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:
19133-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-2886
Provider Business Practice Location Address Fax Number:
215-227-0114
Provider Enumeration Date:
11/22/2005