Provider First Line Business Practice Location Address:
125 N 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 1R
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-613-6523
Provider Business Practice Location Address Fax Number:
215-922-2228
Provider Enumeration Date:
05/13/2014