Provider First Line Business Practice Location Address:
809 N 2ND 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:
19123-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-733-9606
Provider Business Practice Location Address Fax Number:
215-733-9607
Provider Enumeration Date:
12/06/2006