Provider First Line Business Practice Location Address:
5537 MARKET 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:
19139-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-278-1647
Provider Business Practice Location Address Fax Number:
215-476-9821
Provider Enumeration Date:
03/03/2009