Provider First Line Business Practice Location Address:
5601 CHRISTIAN 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:
19143-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-2908
Provider Business Practice Location Address Fax Number:
215-471-3807
Provider Enumeration Date:
03/24/2011