Provider First Line Business Practice Location Address:
245 S 16TH 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:
19102-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-552-6928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2014