Provider First Line Business Practice Location Address:
1940 W ALLEGHENY AVE
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:
19132-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-264-1801
Provider Business Practice Location Address Fax Number:
267-286-8250
Provider Enumeration Date:
12/04/2006