Provider First Line Business Practice Location Address:
1626 S 53RD 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:
19143-5444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-597-2710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2014