Provider First Line Business Practice Location Address:
7927 FAIRFIELD 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:
19152-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-299-5959
Provider Business Practice Location Address Fax Number:
267-343-8433
Provider Enumeration Date:
07/02/2006