Provider First Line Business Practice Location Address:
2290 N 53RD 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:
19131-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-477-2448
Provider Business Practice Location Address Fax Number:
215-877-2856
Provider Enumeration Date:
07/25/2006