Provider First Line Business Practice Location Address:
272 S 56TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-551-5620
Provider Business Practice Location Address Fax Number:
215-474-4850
Provider Enumeration Date:
02/13/2013