Provider First Line Business Practice Location Address:
134 W MANHEIM 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:
19144-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-605-3325
Provider Business Practice Location Address Fax Number:
215-424-2372
Provider Enumeration Date:
12/07/2018