Provider First Line Business Practice Location Address:
933 SPRING 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:
19107-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-574-9388
Provider Business Practice Location Address Fax Number:
215-574-9188
Provider Enumeration Date:
06/28/2006