Provider First Line Business Practice Location Address:
5523 HARBISON AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-227-4500
Provider Business Practice Location Address Fax Number:
267-227-4500
Provider Enumeration Date:
11/10/2015