Provider First Line Business Practice Location Address:
1709 W RITNER 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:
19145-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-462-0551
Provider Business Practice Location Address Fax Number:
215-462-0552
Provider Enumeration Date:
07/02/2007