Provider First Line Business Practice Location Address:
2418 E YORK 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:
19125-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-217-6438
Provider Business Practice Location Address Fax Number:
806-454-5682
Provider Enumeration Date:
06/20/2024