Provider First Line Business Practice Location Address:
2036-38 SOUTH 3RD STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-468-2111
Provider Business Practice Location Address Fax Number:
215-468-0387
Provider Enumeration Date:
11/11/2009