Provider First Line Business Practice Location Address:
933 E SHARPNACK ST
Provider Second Line Business Practice Location Address:
SIDE ENTRANCE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19150-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-289-2487
Provider Business Practice Location Address Fax Number:
215-933-5588
Provider Enumeration Date:
07/14/2012