Provider First Line Business Practice Location Address:
3187 S UBER 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:
19145-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-592-8721
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2025