Provider First Line Business Practice Location Address:
6001 N 5TH STREET
Provider Second Line Business Practice Location Address:
OFFICE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19120-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-335-2647
Provider Business Practice Location Address Fax Number:
267-535-3086
Provider Enumeration Date:
08/19/2016