Provider First Line Business Practice Location Address:
2230 E ALLEGHENY AVE
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:
19134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-3418
Provider Business Practice Location Address Fax Number:
215-364-4872
Provider Enumeration Date:
12/06/2005