Provider First Line Business Practice Location Address:
1017 S FAIRHILL 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:
19147-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-690-1336
Provider Business Practice Location Address Fax Number:
215-392-3462
Provider Enumeration Date:
12/06/2021