Provider First Line Business Practice Location Address:
3820 N 2ND 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:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-7567
Provider Business Practice Location Address Fax Number:
215-483-8143
Provider Enumeration Date:
02/22/2013