Provider First Line Business Practice Location Address:
6735 HARBISON 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:
19149-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-672-2436
Provider Business Practice Location Address Fax Number:
215-672-2437
Provider Enumeration Date:
08/15/2012