Provider First Line Business Practice Location Address:
2129-31 S. 7TH STREET
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:
19148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-928-2600
Provider Business Practice Location Address Fax Number:
267-928-2841
Provider Enumeration Date:
11/05/2013