Provider First Line Business Practice Location Address:
7051 PASSYUNK 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:
19142-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-492-1079
Provider Business Practice Location Address Fax Number:
215-492-1083
Provider Enumeration Date:
03/26/2008