Provider First Line Business Practice Location Address:
3380 MEMPHIS ST
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:
19134-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-426-5566
Provider Business Practice Location Address Fax Number:
215-739-3904
Provider Enumeration Date:
11/02/2005