Provider First Line Business Practice Location Address:
1332 W RITNER 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:
19148-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-319-1939
Provider Business Practice Location Address Fax Number:
267-319-1483
Provider Enumeration Date:
04/22/2011