Provider First Line Business Practice Location Address:
1809-13 OREGON AVE
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-465-3435
Provider Business Practice Location Address Fax Number:
215-755-4412
Provider Enumeration Date:
03/17/2006