Provider First Line Business Practice Location Address:
216 W. SOMERSET ST
Provider Second Line Business Practice Location Address:
ESFUERZO PROGRAM
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-576-9611
Provider Business Practice Location Address Fax Number:
215-223-2936
Provider Enumeration Date:
10/07/2015