Provider First Line Business Practice Location Address:
2701 CASTOR 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:
19134-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-305-9051
Provider Business Practice Location Address Fax Number:
215-305-9051
Provider Enumeration Date:
07/24/2006