Provider First Line Business Practice Location Address:
1443 S 7TH 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:
19147-5847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-463-7748
Provider Business Practice Location Address Fax Number:
215-463-3479
Provider Enumeration Date:
06/08/2014