Provider First Line Business Practice Location Address:
3801 FILBERT ST.
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BUILDING 1ST FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-9908
Provider Business Practice Location Address Fax Number:
215-243-4658
Provider Enumeration Date:
08/21/2019