Provider First Line Business Practice Location Address:
3319 KENSINGTON AVE
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:
19134-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-778-2504
Provider Business Practice Location Address Fax Number:
215-426-4437
Provider Enumeration Date:
06/15/2007