Provider First Line Business Practice Location Address:
3156 KENSINGTON 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:
19134-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-302-3156
Provider Business Practice Location Address Fax Number:
215-329-2000
Provider Enumeration Date:
09/28/2017