Provider First Line Business Practice Location Address:
1444 W PASSYUNK 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:
19145-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-755-3070
Provider Business Practice Location Address Fax Number:
215-755-3143
Provider Enumeration Date:
03/24/2006