Provider First Line Business Practice Location Address:
3357 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:
19140-5807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-2444
Provider Business Practice Location Address Fax Number:
215-634-2447
Provider Enumeration Date:
08/01/2011