Provider First Line Business Practice Location Address:
230 N 65TH 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:
19139-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-8224
Provider Business Practice Location Address Fax Number:
215-471-8221
Provider Enumeration Date:
05/19/2008