Provider First Line Business Practice Location Address:
2869 HOLME 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:
19152-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-4070
Provider Business Practice Location Address Fax Number:
215-676-4071
Provider Enumeration Date:
02/24/2009