Provider First Line Business Practice Location Address:
148 N 3RD 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:
19106-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-217-7955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2020