Provider First Line Business Practice Location Address:
1008 ARCH 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:
19107-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-268-7755
Provider Business Practice Location Address Fax Number:
215-627-2985
Provider Enumeration Date:
03/01/2007