Provider First Line Business Practice Location Address:
861 E ALLEGHENY 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:
19134-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-807-8620
Provider Business Practice Location Address Fax Number:
215-291-5640
Provider Enumeration Date:
06/10/2025