Provider First Line Business Practice Location Address:
2716 SOUTH STREET
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH 8/8473
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-425-1328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2017