Provider First Line Business Practice Location Address:
433 CATHARINE 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:
19147-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-679-2959
Provider Business Practice Location Address Fax Number:
215-592-6517
Provider Enumeration Date:
09/29/2014