Provider First Line Business Practice Location Address:
3609 CHESTNUT 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:
19104-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-386-2942
Provider Business Practice Location Address Fax Number:
215-386-3335
Provider Enumeration Date:
05/31/2006