Provider First Line Business Practice Location Address:
1618 SOUTH ST
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-575-5085
Provider Business Practice Location Address Fax Number:
215-278-2965
Provider Enumeration Date:
06/24/2010