Provider First Line Business Practice Location Address:
6628 WOODLAND AVE
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19142-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-343-2412
Provider Business Practice Location Address Fax Number:
215-379-1239
Provider Enumeration Date:
08/27/2013