Provider First Line Business Practice Location Address:
2314 E YORK 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:
19125-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-0525
Provider Business Practice Location Address Fax Number:
215-634-8402
Provider Enumeration Date:
05/27/2006