Provider First Line Business Practice Location Address:
2578 ORTHODOX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19137-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-533-7175
Provider Business Practice Location Address Fax Number:
215-533-6026
Provider Enumeration Date:
01/10/2006