Provider First Line Business Practice Location Address:
2130 N PALETHORP 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:
19122-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-972-0534
Provider Business Practice Location Address Fax Number:
215-425-4042
Provider Enumeration Date:
04/24/2008