Provider First Line Business Practice Location Address:
2449 N. 54TH STREET
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:
19131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-668-0610
Provider Business Practice Location Address Fax Number:
125-878-4016
Provider Enumeration Date:
07/15/2009