Provider First Line Business Practice Location Address:
7700 CRITTENDEN ST
Provider Second Line Business Practice Location Address:
UNIT 33A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-242-3141
Provider Business Practice Location Address Fax Number:
215-242-4212
Provider Enumeration Date:
03/13/2007