Provider First Line Business Practice Location Address:
3810 MORRELL 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:
19114-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-6698
Provider Business Practice Location Address Fax Number:
215-568-0661
Provider Enumeration Date:
01/09/2014