Provider First Line Business Practice Location Address:
1733 SPRING GARDEN 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:
19130-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-639-2706
Provider Business Practice Location Address Fax Number:
267-639-2699
Provider Enumeration Date:
01/04/2013