Provider First Line Business Practice Location Address:
830 N BUCKNELL 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:
19130-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-769-1496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2008