Provider First Line Business Practice Location Address:
1837 S 65TH 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:
19142-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-726-0181
Provider Business Practice Location Address Fax Number:
215-726-5110
Provider Enumeration Date:
06/25/2005