Provider First Line Business Practice Location Address:
5129 N 5TH ST
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:
19120-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-918-1958
Provider Business Practice Location Address Fax Number:
215-827-5231
Provider Enumeration Date:
09/19/2017