Provider First Line Business Practice Location Address:
221 VINE 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:
19106-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-3040
Provider Business Practice Location Address Fax Number:
215-625-9632
Provider Enumeration Date:
03/21/2007