Provider First Line Business Practice Location Address:
237 S 18TH ST
Provider Second Line Business Practice Location Address:
# 21-D
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-6161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-830-9991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2013