Provider First Line Business Practice Location Address:
2437 S. 24TH ST.
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-468-3469
Provider Business Practice Location Address Fax Number:
215-468-3934
Provider Enumeration Date:
01/08/2007