Provider First Line Business Practice Location Address:
1236 N 26TH 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:
19121-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-763-3974
Provider Business Practice Location Address Fax Number:
215-765-1494
Provider Enumeration Date:
06/30/2017