Provider First Line Business Practice Location Address:
241 S 6TH ST
Provider Second Line Business Practice Location Address:
#2010
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-9765
Provider Business Practice Location Address Fax Number:
215-925-2908
Provider Enumeration Date:
06/25/2009