Provider First Line Business Practice Location Address:
3204 KENSINGTON AVE FL 1
Provider Second Line Business Practice Location Address:
1ST FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-1603
Provider Business Practice Location Address Fax Number:
215-427-3590
Provider Enumeration Date:
01/07/2015