Provider First Line Business Practice Location Address:
2525 S. &3RD STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-859-6132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026