Provider First Line Business Practice Location Address:
2623 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:
19134-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-423-2030
Provider Business Practice Location Address Fax Number:
215-423-2344
Provider Enumeration Date:
09/20/2005