Provider First Line Business Practice Location Address:
739 N 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-763-2265
Provider Business Practice Location Address Fax Number:
215-763-4146
Provider Enumeration Date:
01/28/2010