Provider First Line Business Practice Location Address:
211 FITZWATER 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:
19147-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-779-8603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2008