Provider First Line Business Practice Location Address:
118 DIAMOND 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:
19122-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-763-7080
Provider Business Practice Location Address Fax Number:
215-763-7515
Provider Enumeration Date:
02/07/2007