Provider First Line Business Practice Location Address:
2136 W PASSYUNK 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:
19145-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-271-0101
Provider Business Practice Location Address Fax Number:
215-334-7259
Provider Enumeration Date:
03/06/2007