Provider First Line Business Practice Location Address:
3823 MARKET 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:
19104-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-222-0671
Provider Business Practice Location Address Fax Number:
215-823-6949
Provider Enumeration Date:
04/08/2006