Provider First Line Business Practice Location Address:
1607 BRIDGE 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:
19124-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-537-0169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2017