Provider First Line Business Practice Location Address:
2641 N 6TH 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:
19133-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-9700
Provider Business Practice Location Address Fax Number:
215-291-0626
Provider Enumeration Date:
06/04/2007