Provider First Line Business Practice Location Address:
2541 N 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-237-6640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2008