Provider First Line Business Practice Location Address:
1401 S 31ST 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:
19146-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-755-6866
Provider Business Practice Location Address Fax Number:
215-334-1381
Provider Enumeration Date:
01/29/2018