Provider First Line Business Practice Location Address:
7178 N UBER STREET
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:
19138-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-833-5577
Provider Business Practice Location Address Fax Number:
215-833-5577
Provider Enumeration Date:
12/26/2017