Provider First Line Business Practice Location Address:
3803-3805 NORTH 5TH 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:
18140-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-221-9136
Provider Business Practice Location Address Fax Number:
484-221-9130
Provider Enumeration Date:
06/30/2015