Provider First Line Business Practice Location Address:
1920 N. 20TH 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:
19121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-2973
Provider Business Practice Location Address Fax Number:
215-765-2409
Provider Enumeration Date:
06/24/2007