Provider First Line Business Practice Location Address:
1614 E UPSAL 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:
19150-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-276-9090
Provider Business Practice Location Address Fax Number:
215-276-8105
Provider Enumeration Date:
01/06/2007