Provider First Line Business Practice Location Address:
67 E BRINGHURST ST
Provider Second Line Business Practice Location Address:
JOHN WISTER ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19144-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-951-4003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2014