Provider First Line Business Practice Location Address:
1530 W MOYAMENSING 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:
19145-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-465-1318
Provider Business Practice Location Address Fax Number:
215-465-1319
Provider Enumeration Date:
06/06/2009