Provider First Line Business Practice Location Address:
2506 W OAKDALE 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:
19132-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-987-9273
Provider Business Practice Location Address Fax Number:
215-607-2983
Provider Enumeration Date:
05/20/2022