Provider First Line Business Practice Location Address:
1620 OREGON 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:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-336-6868
Provider Business Practice Location Address Fax Number:
215-336-8088
Provider Enumeration Date:
12/18/2008