Provider First Line Business Practice Location Address:
2927 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:
19133-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-221-9136
Provider Business Practice Location Address Fax Number:
484-221-9130
Provider Enumeration Date:
11/13/2007