Provider First Line Business Practice Location Address:
2510 N FRONT STREET
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:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-278-2289
Provider Business Practice Location Address Fax Number:
215-278-2332
Provider Enumeration Date:
05/01/2007