Provider First Line Business Practice Location Address:
603 WASHINGTON AVE
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:
19147-4825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-218-4025
Provider Business Practice Location Address Fax Number:
215-952-0847
Provider Enumeration Date:
02/23/2010