Provider First Line Business Practice Location Address:
1822 SPRING GARDEN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-564-0680
Provider Business Practice Location Address Fax Number:
215-564-0732
Provider Enumeration Date:
05/30/2012