Provider First Line Business Practice Location Address:
923 ARCH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-9830
Provider Business Practice Location Address Fax Number:
215-925-0792
Provider Enumeration Date:
01/28/2015