Provider First Line Business Practice Location Address:
3200 N 5TH 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:
19140-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-918-9072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2024