Provider First Line Business Practice Location Address:
2174 E YORK ST
Provider Second Line Business Practice Location Address:
APT. 2
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-964-8658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2014