Provider First Line Business Practice Location Address:
245 S SAINT BERNARD 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:
19139-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-378-3140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2022