Provider First Line Business Practice Location Address:
121 N 9TH 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:
19107-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-345-3532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2010