Provider First Line Business Practice Location Address:
49 N 52ND 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:
19139-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-472-2550
Provider Business Practice Location Address Fax Number:
215-472-2551
Provider Enumeration Date:
04/14/2017