Provider First Line Business Practice Location Address:
248 S 21ST 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:
19103-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-732-3350
Provider Business Practice Location Address Fax Number:
215-732-2424
Provider Enumeration Date:
09/08/2006