Provider First Line Business Practice Location Address:
151 N 9TH STREET
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:
19107-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-501-3649
Provider Business Practice Location Address Fax Number:
215-501-5511
Provider Enumeration Date:
11/10/2016