Provider First Line Business Practice Location Address:
3224 LONGSHORE 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:
19149-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-7079
Provider Business Practice Location Address Fax Number:
215-331-6370
Provider Enumeration Date:
10/13/2008