Provider First Line Business Practice Location Address:
1417 W OREGON 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:
19145-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-1311
Provider Business Practice Location Address Fax Number:
215-334-4512
Provider Enumeration Date:
11/03/2008