Provider First Line Business Practice Location Address:
5615 HADFIELD 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:
19143-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-200-8584
Provider Business Practice Location Address Fax Number:
215-727-5642
Provider Enumeration Date:
12/07/2009