Provider First Line Business Practice Location Address:
350 W DURHAM 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:
19119-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-584-7093
Provider Business Practice Location Address Fax Number:
718-779-7775
Provider Enumeration Date:
01/19/2007