Provider First Line Business Practice Location Address:
700 E PASSYUNK 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:
19147-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-351-1603
Provider Business Practice Location Address Fax Number:
215-351-1609
Provider Enumeration Date:
08/30/2005