Provider First Line Business Practice Location Address:
132 S 10TH ST
Provider Second Line Business Practice Location Address:
FL 2 RM 285K
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-503-5642
Provider Business Practice Location Address Fax Number:
215-503-4817
Provider Enumeration Date:
04/11/2013