Provider First Line Business Practice Location Address:
908 S 8TH 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:
19147-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-238-5727
Provider Business Practice Location Address Fax Number:
215-413-0729
Provider Enumeration Date:
07/17/2006