Provider First Line Business Practice Location Address:
3217 W CLEARFIELD 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:
19132-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-266-3194
Provider Business Practice Location Address Fax Number:
215-689-2412
Provider Enumeration Date:
03/08/2019