Provider First Line Business Practice Location Address:
3169 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:
19133-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-6869
Provider Business Practice Location Address Fax Number:
215-425-6125
Provider Enumeration Date:
05/07/2013