Provider First Line Business Practice Location Address:
2326 S 3RD 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:
19148-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-551-9151
Provider Business Practice Location Address Fax Number:
215-334-5785
Provider Enumeration Date:
05/05/2008