Provider First Line Business Practice Location Address:
7332 ELGIN 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:
19111-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-725-8240
Provider Business Practice Location Address Fax Number:
267-672-3171
Provider Enumeration Date:
01/30/2007