Provider First Line Business Practice Location Address:
2516 S WARNOCK 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:
19148-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-971-9192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2009