Provider First Line Business Practice Location Address:
FRONT STREET AND ERIE AVENUE
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:
19134-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-429-5109
Provider Business Practice Location Address Fax Number:
215-427-3860
Provider Enumeration Date:
05/10/2006