Provider First Line Business Practice Location Address:
2224 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:
19145-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-465-6061
Provider Business Practice Location Address Fax Number:
215-465-0549
Provider Enumeration Date:
07/15/2008