Provider First Line Business Practice Location Address:
8016 HALSTEAD ST
Provider Second Line Business Practice Location Address:
PHILADELPHIA
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-779-0069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006