Provider First Line Business Practice Location Address:
251 E BRINGHURST 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:
19144-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-844-1020
Provider Business Practice Location Address Fax Number:
215-844-2702
Provider Enumeration Date:
12/15/2020