Provider First Line Business Practice Location Address:
201 W SPENCER AVE
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:
19120-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-309-5701
Provider Business Practice Location Address Fax Number:
215-309-5713
Provider Enumeration Date:
09/28/2015