Provider First Line Business Practice Location Address:
1428 WOLF ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-271-4130
Provider Business Practice Location Address Fax Number:
215-271-4130
Provider Enumeration Date:
01/11/2007