Provider First Line Business Practice Location Address:
3000 N 22ND 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:
19132-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-223-6549
Provider Business Practice Location Address Fax Number:
215-223-3670
Provider Enumeration Date:
03/04/2015