Provider First Line Business Practice Location Address:
3228 N 20TH STREET
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:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
445-800-5022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2025