Provider First Line Business Practice Location Address:
1316 E BARRINGER 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:
19119-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-770-5372
Provider Business Practice Location Address Fax Number:
215-770-5379
Provider Enumeration Date:
12/30/2021