Provider First Line Business Practice Location Address:
105 E JOHNSON 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:
19144-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-1697
Provider Business Practice Location Address Fax Number:
215-844-2475
Provider Enumeration Date:
12/27/2017