Provider First Line Business Practice Location Address:
612-614 SNYDER AVE
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:
19148-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-560-8161
Provider Business Practice Location Address Fax Number:
215-608-8376
Provider Enumeration Date:
03/01/2016