Provider First Line Business Practice Location Address:
2416 E ALLEGHENY 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:
19134-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-426-8637
Provider Business Practice Location Address Fax Number:
215-423-8637
Provider Enumeration Date:
08/31/2021