Provider First Line Business Practice Location Address:
51 NORTH 39TH STREET
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING, 1ST FLOOR, SUITE 120
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-489-5919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2023