Provider First Line Business Practice Location Address:
4601 ENFIELD 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:
19136-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-760-3168
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2026