Provider First Line Business Practice Location Address:
3231 N 2ND 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:
19140-5853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-494-9902
Provider Business Practice Location Address Fax Number:
215-494-9905
Provider Enumeration Date:
05/09/2014