Provider First Line Business Practice Location Address:
2655 S 10TH 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:
19148-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-467-6050
Provider Business Practice Location Address Fax Number:
215-467-3573
Provider Enumeration Date:
12/09/2011