Provider First Line Business Practice Location Address:
501 S 53RD 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:
19143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-994-8417
Provider Business Practice Location Address Fax Number:
215-748-9009
Provider Enumeration Date:
11/21/2014