Provider First Line Business Practice Location Address:
157 W CARPENTER AVENUE
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:
19117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-843-8066
Provider Business Practice Location Address Fax Number:
215-843-2842
Provider Enumeration Date:
01/03/2008