Provider First Line Business Practice Location Address:
1711 CHESTNUT 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:
19103-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-546-2227
Provider Business Practice Location Address Fax Number:
215-546-9278
Provider Enumeration Date:
01/23/2007