Provider First Line Business Practice Location Address:
606 S. 6TH ST.
Provider Second Line Business Practice Location Address:
3R
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-420-5114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014