Provider First Line Business Practice Location Address:
6529 N 20TH 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:
19138-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-549-3252
Provider Business Practice Location Address Fax Number:
215-549-3252
Provider Enumeration Date:
03/24/2007