Provider First Line Business Practice Location Address:
1803 S BANCROFT 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:
19145-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-896-9650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2016