Provider First Line Business Practice Location Address:
2734 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:
19134-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-2786
Provider Business Practice Location Address Fax Number:
215-427-2788
Provider Enumeration Date:
01/06/2011