Provider First Line Business Practice Location Address:
3808 SHARP 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:
19127-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-482-3031
Provider Business Practice Location Address Fax Number:
215-625-6766
Provider Enumeration Date:
01/15/2007