Provider First Line Business Practice Location Address:
3251 N FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-1422
Provider Business Practice Location Address Fax Number:
215-425-1433
Provider Enumeration Date:
06/24/2006