Provider First Line Business Practice Location Address:
512 S 3RD ST UNIT A
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:
19147-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-433-0260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2012