Provider First Line Business Practice Location Address:
2551 ORTHODOX 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:
19137-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-278-6853
Provider Business Practice Location Address Fax Number:
215-689-4297
Provider Enumeration Date:
01/13/2026