Provider First Line Business Practice Location Address:
1224 E HUNTING PARK AVE
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:
19124-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-743-6685
Provider Business Practice Location Address Fax Number:
215-743-6686
Provider Enumeration Date:
12/09/2008