Provider First Line Business Practice Location Address:
4823 N FRONT 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:
19120-4213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-960-4444
Provider Business Practice Location Address Fax Number:
215-960-4445
Provider Enumeration Date:
07/05/2011