Provider First Line Business Practice Location Address:
2340 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:
19134-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-608-8937
Provider Business Practice Location Address Fax Number:
267-459-5831
Provider Enumeration Date:
06/11/2009