Provider First Line Business Practice Location Address:
826 CHRISTIAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-3450
Provider Business Practice Location Address Fax Number:
215-923-5871
Provider Enumeration Date:
08/03/2006