Provider First Line Business Practice Location Address:
1823 CALLOWHILL 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:
19130-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-496-0707
Provider Business Practice Location Address Fax Number:
215-496-0742
Provider Enumeration Date:
06/12/2007