Provider First Line Business Practice Location Address:
716 N 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-765-7745
Provider Business Practice Location Address Fax Number:
215-765-2550
Provider Enumeration Date:
03/29/2007