Provider First Line Business Practice Location Address:
3360 N HOWARD ST
Provider Second Line Business Practice Location Address:
C1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-498-0205
Provider Business Practice Location Address Fax Number:
856-382-7412
Provider Enumeration Date:
10/08/2015