Provider First Line Business Practice Location Address:
9150 MARSHAL ST
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-698-1142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006