Provider First Line Business Practice Location Address:
6841 KINDRED 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:
19149-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-252-4306
Provider Business Practice Location Address Fax Number:
215-722-2699
Provider Enumeration Date:
01/21/2009