Provider First Line Business Practice Location Address:
2419 E ALLEGHENY 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:
19134-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-771-5157
Provider Business Practice Location Address Fax Number:
215-220-3561
Provider Enumeration Date:
08/06/2018