Provider First Line Business Practice Location Address:
1302 KERBAUGH 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:
19140-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-461-6849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2026