Provider First Line Business Practice Location Address:
4545 N FRONT 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:
19140-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-514-6297
Provider Business Practice Location Address Fax Number:
215-613-5652
Provider Enumeration Date:
08/15/2012