Provider First Line Business Practice Location Address:
5619 25 VINE STREET
Provider Second Line Business Practice Location Address:
HADDINGTON HEALTH CENTER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-2671
Provider Business Practice Location Address Fax Number:
215-471-1079
Provider Enumeration Date:
06/05/2006