Provider First Line Business Practice Location Address:
2351 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-0324
Provider Business Practice Location Address Fax Number:
215-427-0308
Provider Enumeration Date:
02/08/2011