Provider First Line Business Practice Location Address:
1701 W RITNER 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:
19145-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-336-2145
Provider Business Practice Location Address Fax Number:
215-336-5732
Provider Enumeration Date:
08/30/2006