Provider First Line Business Practice Location Address:
706 S 11TH ST
Provider Second Line Business Practice Location Address:
#3B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-913-7381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2010