Provider First Line Business Practice Location Address:
7618 OGONTZ 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:
19150-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-323-2778
Provider Business Practice Location Address Fax Number:
267-323-2774
Provider Enumeration Date:
09/21/2011