Provider First Line Business Practice Location Address:
1801 S 20TH 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:
19145-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-465-4465
Provider Business Practice Location Address Fax Number:
215-465-4489
Provider Enumeration Date:
05/24/2007