Provider First Line Business Practice Location Address:
712 N FRANKLIN ST
Provider Second Line Business Practice Location Address:
2 REAR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-264-5575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2008